Effect of septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy and the change of left atrial function after procedure

doi:10.3877/cma.j.issn.1672-6448.2016.03.005

Abstract

Abstract:

Objective

To evaluate the effect of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and the change of left atrial volume after PTSMA by three-dimensional echocardiography (3DE).

Methods

Thirty-four patients with HOCM were enrolled in this study. Echocardiography was done at 1 week before PTSMA, 1 week and 1 year after PTSMA. Left ventricular end-diastolic diameter (LVd), 1eft atrial diameter (LAd), interventricular septal thickness (IVSd), 1eft ventricular posterior wall thickness (LVPWd), 1eft ventricular ejection fraction (LVEF) and left ventricular out?ow tract peak gradient (LVOT-PG) etc. were acquired by conventional echocardiography. Time-volume curve of left atrium was acquired by 3DE. Left atrial maximal volume (LAVmax), 1eft atrial minimal volume (LAVmin) and 1eft atrial pre-systolic volume (LAVp) were acquaired. Left atrium emptying fraction (LAEF), left atrium passive emptying fraction (LAPEF), left atrium active emptying fraction (LAAEF) and left atrial expansion index (LAEI) were calculated. Comparative analysis was done between before and after PTSMA.

Results

Compared with pre-procedure, LVOT-PG (54.5±34.5) mmHg (1 mmHg=0.133 kPa), LVEF (71.4±5.7)%, LAVmax (90.2±36.5) ml, LAVp (73.0±34.0) ml and LAVmin (53.2±28.8) ml decreased significantly (t=4.002, 3.234, 3.502, 3.611, 2.253, P<0.05) at 1 week after PTSMA; LVOT-PG (38.3±31.7) mmHg, IVSd (16.7±8.3) mm, LVPWd (11.0±1.9) mm, E/e′ 12.0±4.6, LAVmax (80.9±24.8)ml, LAVp (61.3±23.1) ml, LAVmin (42.6±19.5)ml, MI (1.46±1.06) decreased signi?cantly (t=5.371, 4.165, 3.473, 3.940, 3.655, 4.046, 4.046, z=-2.873, P<0.01), but LAPEF (25.1±5.1)% increased signi?cantly (t=-3.270, P<0.01) at 1 year after PTSMA. Compared with 1 week follow-up, LVOT-PG, IVSd, LVPWd, LAVmax, LAVp, LAVmin, MI decreased significantly (t=2.256, 5.067, 3.137, 2.200, 2.740, 2.016, Z=-2.003, P<0.05), but LVd (41.6±4.0) mm, LAEF (48.3±7.9)% and LAPEF increased signi?cantly (t=-2.288, -2.725, -2.907, P<0.05) at 1 year follow-up.

Conclusions

For the patients with HOCM after PTSMA, left ventricular outflow tract obstruction relieved, left ventricular filling pressure decreased, and mitral regurgitation improved. 3DE is more accurate and sensitive than two-dimensional echocardiography to evaluate left atrial size. For the patients with HOCM after PTSMA, left atrial volume decreased progressively.

Key words: Echocardiography, Cardiomyopathy, hypertrophic, Ventricular function, left, Percutaneous transluminal septal myocardial ablation

Yiming Gao, Jianpeng Wang, Xing Zhao, Hui Li, Fujian Duan, Shubin Qiao, Hao Wang. Effect of septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy and the change of left atrial function after procedure[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(03): 185-190.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2016.03.005

https://chaosheng.cma-cmc.com.cn/EN/Y2016/V13/I03/185

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References 19

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组别	例数	IVSd（mm）	LVPWd（mm）	Lad（mm）	LVd（mm）	LVEF（%）	LVOT-PG	平均E/e′	MI
术前	34	22.8±5.2	12.4±2.4	40.8±5.1	40.1±4.7	76.7±6.2	84.3±26.7	16.7±4.9	2.17±0.48
术后1周	34	23.2±6.2	12.1±2.3	39.8±5.9	39.2±4.6	71.4±5.7^a	54.5±34.5^a	14.0±6.2	1.88±0.68
术后1年	34	16.7±8.3^b，c	11.0±1.9^b，c	39.2±6.4	41.6±4.0^c	73.5±6.2	38.3±31.7^b，c	12.0±4.6^b	1.46±1.06^b，c

组别	例数	IVSd（mm）	LVPWd（mm）	Lad（mm）	LVd（mm）	LVEF（%）	LVOT-PG	平均E/e′	MI
术前	34	22.8±5.2	12.4±2.4	40.8±5.1	40.1±4.7	76.7±6.2	84.3±26.7	16.7±4.9	2.17±0.48
术后1周	34	23.2±6.2	12.1±2.3	39.8±5.9	39.2±4.6	71.4±5.7^a	54.5±34.5^a	14.0±6.2	1.88±0.68
术后1年	34	16.7±8.3^b，c	11.0±1.9^b，c	39.2±6.4	41.6±4.0^c	73.5±6.2	38.3±31.7^b，c	12.0±4.6^b	1.46±1.06^b，c

组别	例数	LAVmax（ml）	LAVp（ml）	LAVmin（ml）	LAEF（%）	LAPEF（%）	LAAEF（%）	LAEI（%）
术前	30	98.6±36.1	79.8±32.7	57.5±27.5	42.5±11.1	19.7±5.4	28.8±10.3	0.8±0.4
术后1周	30	90.2±36.5	73.0±34.0	53.2±28.8	43.0±8.2	20.3±6.1	28.8±5.6	0.8±0.2
t值	?	3.502	3.611	2.253	-0.245	-0.535	-0.011	0.235
P值	?	0.002	0.002	0.036	0.809	0.599	0.992	0.817

组别	例数	LAVmax（ml）	LAVp（ml）	LAVmin（ml）	LAEF（%）	LAPEF（%）	LAAEF（%）	LAEI（%）
术前	30	98.6±36.1	79.8±32.7	57.5±27.5	42.5±11.1	19.7±5.4	28.8±10.3	0.8±0.4
术后1周	30	90.2±36.5	73.0±34.0	53.2±28.8	43.0±8.2	20.3±6.1	28.8±5.6	0.8±0.2
t值	?	3.502	3.611	2.253	-0.245	-0.535	-0.011	0.235
P值	?	0.002	0.002	0.036	0.809	0.599	0.992	0.817

组别	例数	LAVmax（ml）	LAVp（ml）	LAVmin（ml）	LAEF（%）	LAPEF（%）	LAAEF（%）	LAEI（%）
术前	25	103.1±38.7	83.6±35.7	60.6±29.6	41.9±11.7	19.9±5.8	27.9±10.8	0.8±0.4
术后1年	25	80.9±24.8	61.3±23.1	42.6±19.5	48.7±8.1	25.1±5.1	31.6±8.5	1.0±0.3
t值	?	3.655	4.046	4.046	-2.140	-3.270	-1.034	-1.740
P值	?	0.003	0.001	0.001	0.050	0.006	0.319	0.104

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