Key result
Virtual 3D models measured a significantly greater maximal interventricular septum thickness compared to 2D TTE (28.6 vs 21.4 mm; MD 7.3 mm, 95% CI 6.4-8.2; P<0.001) for septal myectomy planning.
Why the study?
The study sought to compare the effectiveness of virtual 3D models with 2D TTE for evaluating interventricular septum and abnormal muscle bundle anatomy in septal myectomy planning.
Do virtual 3D models improve the anatomical evaluation of the interventricular septum and abnormal muscle bundles compared to 2D TTE in symptomatic patients with hypertrophic cardiomyopathy planning septal myectomy?
Observational (n=103)
Do virtual 3D models improve the anatomical evaluation of the interventricular septum and abnormal muscle bundles compared to 2D TTE in symptomatic patients with hypertrophic cardiomyopathy planning septal myectomy?
Mean Difference: 7.3 (95% CI 6.4–8.2)
Absolute Event Rate: 28.6% vs 21.4%
p-value: p=<0.001
Virtual 3D models derived from CMR or CTA provide more accurate anatomical assessment of the interventricular septum and abnormal muscle bundles than 2D TTE for planning septal myectomy.
Virtual 3D models may aid IVS/AMB assessment for SM planning in HCM; leaves open whether they improve outcomes over 2D TTE.
OBJECTIVES: We compared the effectiveness of virtual 3-dimensional (3D) models with 2-dimensional (2D) transthoracic echocardiography (TTE) for evaluating the anatomy of the interventricular septum (IVS) and abnormal muscle bundles (AMBs) in planning septal myectomy (SM). METHODS: Between January 2017 and July 2020, 103 consecutive symptomatic patients with hypertrophic cardiomyopathy underwent 2D TTE and cardiovascular magnetic resonance imaging in 49 (47.6%) or computed tomography angiography in 54 (52.4%) patients with 3D IVS modelling for SM planning. We evaluated maximal IVS thickness and location, length and thickness of AMBs. RESULTS: The mean maximal IVS thickness by 2D TTE was 7.3 [standard deviation (SD) 4.8] mm less than that based on the 3D model analysis: 21.4 (SD 3.7) vs 28.6 (SD 5.5) mm, respectively (P < 0.001, 95% confidence interval 6.4-8.2). The planned volume of ideal SM was larger than that of performed SM: 26.2 (18.4-39.4) vs 10.3 (7.4-12.8) cm3, respectively (P < 0.001). The sensitivity and specificity of 2D TTE in diagnosing AMBs were 36.9% and 95%, and those of cardiovascular magnetic resonance and computed tomography angiography with 3D modelling were 97.1% and 100% for cardiovascular magnetic resonance and 98% and 100% for computed tomography angiography, respectively. AMBs occurred in 84 (81.6%) patients. No patient required mitral valve replacement. The 30-day mortality was 1 patient. There were 4 late non-cardiac deaths (3.9%) within 18.1 (standard error 1.32) months. CONCLUSIONS: Anatomical analysis of the IVS and AMBs based on their virtual 3D models is highly effective for SM planning.
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Andrushchuk et al. (2021) conducted an observational in Hypertrophic cardiomyopathy (n=103). Virtual 3-dimensional (3D) models vs. 2-dimensional (2D) transthoracic echocardiography (TTE) was evaluated on Maximal interventricular septum (IVS) thickness (MD 7.3, 95% CI 6.4-8.2, p=<0.001). Virtual 3D models measured a significantly greater maximal interventricular septum thickness compared to 2D TTE (28.6 vs 21.4 mm; MD 7.3 mm, 95% CI 6.4-8.2; P<0.001) for septal myectomy planning.
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