Why the study?
To investigate myocardial remodeling using cardiac MRI feature tracking and evaluate the relationship between cardiac MRI parameters and outcomes in patients with HOCM after myectomy.
Does post-myectomy cardiac MRI feature tracking predict composite clinical events in patients with hypertrophic obstructive cardiomyopathy?
Does post-myectomy cardiac MRI feature tracking predict composite clinical events in patients with hypertrophic obstructive cardiomyopathy?
Post-myectomy cardiac MRI feature tracking reveals that impaired global circumferential strain is a prognostic marker for poorer clinical outcomes in patients with HOCM.
Postmyectomy global CS may flag higher-risk HOCM patients; leaves open whether strain monitoring alters management or outcomes.
Purpose To investigate myocardial remodeling using cardiac MRI (CMR) feature tracking (FT) and to explore the relationship between CMR parameters with outcomes in hypertrophic obstructive cardiomyopathy (HOCM) after myectomy. Materials and Methods In this single-center retrospective study, patients with HOCM undergoing myectomy between 2011 and 2019 were included. Pre- and postmyectomy global and regional strains were compared. Healthy participants were included for comparison. Composite events were recorded at follow-up performed after a minimum of 12 months. The paired-samples t test was utilized to compare pre- and postmyectomy variables. Results A total of 73 patients (44 years ± 14 [SD]; 45 men) were evaluated. Compared with preoperative parameters, global circumferential strain (CS) (−17.6% ± 4.4 vs −16.7% ± 3.9, P = .02) was impaired, but global longitudinal strain (LS) was improved (−9.3% ± 2.8 vs −10.8% ± 3.3, P < .001). Septal CS (−14.2% ± 4.0 vs −11.0% ± 4.4, P < .001) and septal radial strain (RS) (16.4% ± 10.6 vs 13.7% ± 9.5, P = .007) worsened, while septal LS (−8.1% ± 3.5 vs −10.2% ± 3.4, P < .001), lateral RS (40.1% ± 16.6 vs 54.4% ± 22.6, P < .001), lateral CS (−20.2% ± 4.1 vs −23.1% ± 4.8, P < .001), and lateral LS (−5.6% ± 5.6 vs −8.4% ± 5.2, P = .001) were improved. Sixteen of 73 patients (22%) experienced composite events after median follow-up of 39.1 months. Postoperative global CS provided the highest discrimination for composite event occurrence (area under the receiver operating characteristic curve, 0.73; 95% CI: 0.61, 0.83) with a cutoff of −16.7%. Patients with postoperative global CS greater than −16.7% had reduced event-free survival compared with those with postoperative global CS less than or equal to −16.7% (log-rank P = .002). Conclusion CMR-FT analysis demonstrated longitudinal and lateral restorations, but impaired global CS, after myectomy in patients with HOCM; furthermore, increased global CS was associated with poorer outcomes.
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Yang et al. (2022) studied this question.
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