Assessment of cardiac function in patients with hypertrophic obstructive cardiomyopathy after treatment by percutaneous intramyocardial septal radiofrequency ablation: a 6-month follow-up Study

doi:10.3877/cma.j.issn.1672-6448.2020.05.004

Abstract

Abstract:

Objective

To investigate the cardiac function, myocardial mechanics, hemodynamics, and exercise tolerance in patients with hypertrophic obstructive cardiomyopathy (HOCM) after treatment by percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) using exercise stress echocardiography combined with two-dimensional speckle tracking imaging, and to establish the safety and efficacy of this procedure.

Methods

A consecutive series of 28 HOCM patients treated by PIMSRA at Xijing HCM Center from June 2016 to July 2018 were included and their clinical data were collected. The semi-supine bicycle stress echocardiography was performed within 1 week before and 6 months after PIMSRA. The echocardiographic data at rest and peak exercise were obtained and then compared before and after operation by use of paired t test, chi-square test, or Fisher's exact test.

Results

After PIMSRA, the thickness of the anterior and posterior septal wall, left ventricular mass index (LVMI), and left ventricular end-diastolic dimension (LVEDD) were reduced, and cardiac function class (New York Heart Association, NYHA) was significantly improved (t=6.841, 6.045, 8.699, 4.399, -3.165, χ²=15 567, P<0.05). Besides, the patients were found to have widened left ventricular outflow tract (LVOT), significantly decreased LVOT pressure gradient (LVOT-PG) and velocity time integral (LVOT-VTI), and reduced mitral regurgitation and systolic anterior motion of the mitral valve both at rest or peak exercise after the procedure (rest: t=-6.581, 6.319, 6.256, χ²=23.905, t=2.379; peak exercise: t=-5.351, 6.197, 5.866, χ²=15.286, t=2.747, P<0.05). The left ventricular diastolic function of the patients was significantly improved after PIMSRA with increased early diastolic mitral annular velocity (e') and decreased E/e' ratio, left atrial dimension (LAD), and left atrial volume index (LAVI; t=-2.077, 2.237, 2.376, 2.861, P<0.05). (The left ventricular systolic function measured by conventional echocardiography such as left ventricular ejection fraction (LVEF), systolic mitral annular velocity (s'), and mitral annular plane systolic excursion (MAPSE) did not deteriorate obviously after PIMSRA at rest, and the MAPSE at peak exercise was even slightly increased (t=-2.460, P=0.021) after PIMSRA. Moreover, the left ventricular global radial strain (GRS) and Twist, derived from two-dimensional speckle tracking imaging, were reduced at rest (t=3.518, 4.010, P<0.05) but did not change at peak exercise; while the global longitudinal and circumferential strain (GLS and GCS) did not change either at rest or peak exercise after PIMSRA.

Conclusion

As a safe and effective treatment approach for HOCM, PIMSRA could not only reduce LVOT gradient and mitral regurgitation and improve cardiac function class and living quality, but also improve left ventricular diastolic function without obvious deterioration of systolic function, and reduce Twist to nearly normal level.

Key words: Exercise stress echocardiography, Two-dimensional speckle tracking imaging, Percutaneous intramyocardial septal radiofrequency ablation, Cardiac function, Myocardial mechanics

Kang Chang, Jing Wang, Fan Yang, Nan Kang, Lei Zuo, Mengyao Zhou, Wenxia Li, Bo Wang, Chuang Ye, Liwen Liu. Assessment of cardiac function in patients with hypertrophic obstructive cardiomyopathy after treatment by percutaneous intramyocardial septal radiofrequency ablation: a 6-month follow-up Study[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(05): 409-415.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2020.05.004

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Figures/Tables 2

References 15

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组别	NYHA心功能分级（Ⅰ/Ⅱ/Ⅲ/Ⅳ）	室间隔厚度及左心室内径、质量（±s）
组别	NYHA心功能分级（Ⅰ/Ⅱ/Ⅲ/Ⅳ）	AIVS（mm）	PIVS（mm）	MLVWT（mm）	LVEDD（mm）	LVMI（g/m²）
术前	（6/11/11/0）	25.67±3.76	25.33±4.76	28.19±4.56	38.48±4.66	166.17±43.06
术后6个月	（19/8/1/0）	20.19±3.04	19.37±4.05	22.19±3.09	41.41±3.23	138.81±26.45
统计值	χ²=15.567	t=6.841	t=6.045	t=8.699	t=-3.165	t=4.399
P值	<0.001	<0.001	<0.001	<0.001	0.004	<0.001
组别	左心室流出道及SAM征
组别	LVOT内径（mm，±s）	LVOT-PG（mmHg，±s）	LVOT-VTI（cm，±s）	LVOTO[例（%）]	SAM（无/部分/完全）
术前	5.04±2.93	90.32±49.65	99.30±39.71	24（85.71）	（4/1/23）
术后6个月	10.21±3.93	27.16±32.36	49.59±32.62	6（21.43）	（12/11/5）
统计值	t=-6.581	t=6.319	t=6.256	χ²=23.262	χ²=23.905
P值	<0.001	<0.001	<0.001	<0.001	<0.001
组别	左心室收缩功能（±s）			左心室舒张功能（±s）
组别	LVEF（%）	s′（cm/s）	MAPSE（cm）	e′（cm/s）	E/e′比值	LAD （mm）	LAVI（ml/m²）
术前	60.86±5.54	8.07±1.75	10.36±1.41	5.74±2.08	15.00±7.60	42.00±5.61	34.83±12.75
术后6个月	62.07±4.77	7.67±1.42	10.68±1.93	6.54±2.51	12.71±5.83	39.61±4.10	29.70±10.57
t值	-1.137	1.291	-1.091	-2.077	2.237	2.376	2.861
P值	0.266	0.210	0.285	0.050	0.038	0.025	0.008
组别	左心室心肌机械力学（±s）
组别	GLS（%）	GCS（%）	GRS（%）	ROTB（°）	ROTA（°）	Twist（°）
术前	-13.42±3.49	-18.25±5.53	31.73±8.64	-9.79±5.09	15.51±9.66	25.30±9.51
术后6个月	-14.21±3.37	-16.98±2.85	26.17±7.32	-7.56±3.98	11.45±6.09	19.00±6.45
t值	1.787	-1.257	3.518	-3.230	2.733	4.010
P值	0.085	0.220	0.002	0.003	0.011	<0.001
组别	二尖瓣反流（±s）		左心室血流动力学（±s）
组别	长度（cm）	面积（cm²）	体积（ml）	HR（bpm）	SBP（mmHg）	DBP（mmHg）
术前	3.24±1.03	4.67±2.33	6.00±4.59	71.57±12.11	123.89±15.16	72.57±10.95
术后6个月	2.66±2.33	3.37±2.59	4.04±4.63	65.07±8.32	120.86±19.21	74.04±12.73
t值	2.085	2.379	1.901	3.078	1.006	-0.645
P值	0.047	0.025	0.068	0.005	0.323	0.525

组别	NYHA心功能分级（Ⅰ/Ⅱ/Ⅲ/Ⅳ）	室间隔厚度及左心室内径、质量（±s）
组别	NYHA心功能分级（Ⅰ/Ⅱ/Ⅲ/Ⅳ）	AIVS（mm）	PIVS（mm）	MLVWT（mm）	LVEDD（mm）	LVMI（g/m²）
术前	（6/11/11/0）	25.67±3.76	25.33±4.76	28.19±4.56	38.48±4.66	166.17±43.06
术后6个月	（19/8/1/0）	20.19±3.04	19.37±4.05	22.19±3.09	41.41±3.23	138.81±26.45
统计值	χ²=15.567	t=6.841	t=6.045	t=8.699	t=-3.165	t=4.399
P值	<0.001	<0.001	<0.001	<0.001	0.004	<0.001
组别	左心室流出道及SAM征
组别	LVOT内径（mm，±s）	LVOT-PG（mmHg，±s）	LVOT-VTI（cm，±s）	LVOTO[例（%）]	SAM（无/部分/完全）
术前	5.04±2.93	90.32±49.65	99.30±39.71	24（85.71）	（4/1/23）
术后6个月	10.21±3.93	27.16±32.36	49.59±32.62	6（21.43）	（12/11/5）
统计值	t=-6.581	t=6.319	t=6.256	χ²=23.262	χ²=23.905
P值	<0.001	<0.001	<0.001	<0.001	<0.001
组别	左心室收缩功能（±s）			左心室舒张功能（±s）
组别	LVEF（%）	s′（cm/s）	MAPSE（cm）	e′（cm/s）	E/e′比值	LAD （mm）	LAVI（ml/m²）
术前	60.86±5.54	8.07±1.75	10.36±1.41	5.74±2.08	15.00±7.60	42.00±5.61	34.83±12.75
术后6个月	62.07±4.77	7.67±1.42	10.68±1.93	6.54±2.51	12.71±5.83	39.61±4.10	29.70±10.57
t值	-1.137	1.291	-1.091	-2.077	2.237	2.376	2.861
P值	0.266	0.210	0.285	0.050	0.038	0.025	0.008
组别	左心室心肌机械力学（±s）
组别	GLS（%）	GCS（%）	GRS（%）	ROTB（°）	ROTA（°）	Twist（°）
术前	-13.42±3.49	-18.25±5.53	31.73±8.64	-9.79±5.09	15.51±9.66	25.30±9.51
术后6个月	-14.21±3.37	-16.98±2.85	26.17±7.32	-7.56±3.98	11.45±6.09	19.00±6.45
t值	1.787	-1.257	3.518	-3.230	2.733	4.010
P值	0.085	0.220	0.002	0.003	0.011	<0.001
组别	二尖瓣反流（±s）		左心室血流动力学（±s）
组别	长度（cm）	面积（cm²）	体积（ml）	HR（bpm）	SBP（mmHg）	DBP（mmHg）
术前	3.24±1.03	4.67±2.33	6.00±4.59	71.57±12.11	123.89±15.16	72.57±10.95
术后6个月	2.66±2.33	3.37±2.59	4.04±4.63	65.07±8.32	120.86±19.21	74.04±12.73
t值	2.085	2.379	1.901	3.078	1.006	-0.645
P值	0.047	0.025	0.068	0.005	0.323	0.525

组别	左心室流出道及SAM征
组别	LVOT内径（mm，±s）	LVOT-PG（mm Hg，±s）	LVOT-VTI（cm，±s）	LVOTO[例（%）]	SAM（无/部分/完全）
术前	5.96±2.50	95.67±60.05	82.00±39.22	25（89.29）	（2/5/21）
术后6个月	9.71±3.65	35.41±30.75	47.04±23.38	9（32.14）	（12/9/7）
统计值	t=-5.351	t=6.197	t=5.866	χ²=19.166	χ²=15.286
P值	<0.001	<0.001	<0.001	<0.001	<0.001
组别	左心室收缩功能（±s）		二尖瓣反流（±s）
组别	LVEF（%）	MAPSE（cm）	长度（cm）	面积（cm²）	体积（ml）
术前	60.64±6.64	10.73±1.66	3.34±1.03	4.59±2.73	5.86±5.92
术后6个月	62.50±4.93	11.84±2.52	2.49±2.73	2.95±1.88	3.29±2.55
t值	-1.647	-2.460	3.275	2.747	2.141
P值	0.111	0.021	0.003	0.011	0.041
组别	左心室心肌机械力学（±s）
组别	GLS（%）	GCS（%）	GRS（%）	ROTB（°）	ROTA（°）	Twist（°）
术前	-15.33±4.08	-17.91±3.51	29.45±8.45	-10.17±6.26	16.00±7.55	26.28±10.37
术后6个月	-16.33±3.79	-18.37±4.08	29.29±9.03	-7.70±4.63	17.11±9.50	24.74±11.09
t值	1.971	0.768	0.085	-2.156	-0.582	0.607
P值	0.059	0.449	0.933	0.042	0.566	0.550
组别	左心室血流动力学（±s）			运动能力（±s）
组别	HR（bpm）	SBP（mmHg）	DBP（mmHg）	阻力瓦数（W）	运动时间（s）
术前	118.04±25.18	157.25±22.45	84.14±13.16	85.71±19.75	411.43±94.82
术后6个月	129.04±26.11	164.57±24.47	85.54±13.54	94.64±32.17	454.29±154.43
t值	-2.479	-1.551	-0.514	-1.674	-1.674
P值	0.020	0.133	0.611	0.106	0.106

组别	左心室流出道及SAM征
组别	LVOT内径（mm，±s）	LVOT-PG（mm Hg，±s）	LVOT-VTI（cm，±s）	LVOTO[例（%）]	SAM（无/部分/完全）
术前	5.96±2.50	95.67±60.05	82.00±39.22	25（89.29）	（2/5/21）
术后6个月	9.71±3.65	35.41±30.75	47.04±23.38	9（32.14）	（12/9/7）
统计值	t=-5.351	t=6.197	t=5.866	χ²=19.166	χ²=15.286
P值	<0.001	<0.001	<0.001	<0.001	<0.001
组别	左心室收缩功能（±s）		二尖瓣反流（±s）
组别	LVEF（%）	MAPSE（cm）	长度（cm）	面积（cm²）	体积（ml）
术前	60.64±6.64	10.73±1.66	3.34±1.03	4.59±2.73	5.86±5.92
术后6个月	62.50±4.93	11.84±2.52	2.49±2.73	2.95±1.88	3.29±2.55
t值	-1.647	-2.460	3.275	2.747	2.141
P值	0.111	0.021	0.003	0.011	0.041
组别	左心室心肌机械力学（±s）
组别	GLS（%）	GCS（%）	GRS（%）	ROTB（°）	ROTA（°）	Twist（°）
术前	-15.33±4.08	-17.91±3.51	29.45±8.45	-10.17±6.26	16.00±7.55	26.28±10.37
术后6个月	-16.33±3.79	-18.37±4.08	29.29±9.03	-7.70±4.63	17.11±9.50	24.74±11.09
t值	1.971	0.768	0.085	-2.156	-0.582	0.607
P值	0.059	0.449	0.933	0.042	0.566	0.550
组别	左心室血流动力学（±s）			运动能力（±s）
组别	HR（bpm）	SBP（mmHg）	DBP（mmHg）	阻力瓦数（W）	运动时间（s）
术前	118.04±25.18	157.25±22.45	84.14±13.16	85.71±19.75	411.43±94.82
术后6个月	129.04±26.11	164.57±24.47	85.54±13.54	94.64±32.17	454.29±154.43
t值	-2.479	-1.551	-0.514	-1.674	-1.674
P值	0.020	0.133	0.611	0.106	0.106

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