January 26, 1999Open Access
View Full PaperChanges in Left Ventricular Diastolic Function 6 Months After Nonsurgical Septal Reduction Therapy for Hypertrophic Obstructive Cardiomyopathy
Key Result
Nonsurgical septal reduction therapy significantly reduced LVOT gradient (53.6 to 6 mm Hg, P<0.001) and improved LV relaxation and compliance at 6 months.
Study Design
Type
Observational (n=29)
Structured PICO
Does nonsurgical septal reduction therapy improve left ventricular diastolic function in patients with hypertrophic obstructive cardiomyopathy?
P
Population
29 patients with hypertrophic obstructive cardiomyopathy evaluated at baseline and 6 months after nonsurgical septal reduction therapy.
E
Exposure
Nonsurgical septal reduction therapy (NSRT)
O
Outcome
Changes in left ventricular diastolic function (LV volume, pre-A-wave pressure, early diastolic mitral annulus velocity [Ea], and tau) at 6 monthssurrogate
Nonsurgical septal reduction therapy significantly improves left ventricular relaxation and compliance at 6 months, which correlates with symptomatic and exercise capacity improvements in HOCM patients.
Main Result
p-value: p=<0.01
Abstract
BACKGROUND: Nonsurgical septal reduction therapy (NSRT) decreases left ventricular outflow tract (LVOT) gradient and improves symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). NSRT effects on LV/left ventricular diastolic function are currently unknown. METHODS AND RESULTS: HOCM patients (n=29) had Doppler echocardiography at baseline and 6 months after NSRT to evaluate changes in LV volume, pre-A-wave pressure, early diastolic mitral annulus velocity (Ea) by tissue Doppler, and tau. At 6 months, a significant reduction in LVOT gradient (from 53.6+/-15 to 6+/-5 mm Hg; P<0.001) was accompanied by improvement in exercise duration (from 284+/-147 to 408+/-178 seconds; P=0.04) and New York Health Association class (from III to I; P<0.001). Pre-A pressure (18+/-6 to 14+/-5 mm Hg; P<0.01) and tau (62+/-8 to 51+/-8 ms; P<0.01) decreased, whereas Ea (5.8+/-1.8 to 8+/-1.8 cml/s; P<0.01) and LV end-diastolic volume (117+/-16 to 130+/-22 mL; P<0.01) increased. CONCLUSIONS: NSRT improves LV relaxation and compliance, which contributes to the symptomatic relief seen at 6 months.