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. 2023 Oct;10(5):2939-2947.
doi: 10.1002/ehf2.14481. Epub 2023 Jul 22.

Effects of septal myectomy on left atrial and left ventricular function in obstructive hypertrophic cardiomyopathy

Kyung Eun Ha  1 , Kang-Un Choi  2 , Hee-Jung Lee  1 , Seo-Yeon Gwak  1 , Kyu Kim  1 , Iksung Cho  1 , Geu-Ru Hong  1 , Jong-Won Ha  1 , Chi Young Shim  1
Affiliations

Effects of septal myectomy on left atrial and left ventricular function in obstructive hypertrophic cardiomyopathy

Kyung Eun Ha et al. ESC Heart Fail. 2023 Oct.

Abstract

Aims: Mechanical function of the left atrium (LA) and the left ventricle (LV) has been demonstrated to be a prognostic factor in patients with hypertrophic cardiomyopathy (HCM). We explore whether myocardial mechanical function can be improved by septal reduction therapy in symptomatic obstructive HCM.

Methods and results: Among 65 patients who underwent septal myectomy for symptomatic obstructive HCM from 2006 to 2022, 44 were analysed after excluding those who underwent simultaneous valve repair or replacement or maze operation. LA and LV functional variables including LA strain and LV global longitudinal strain were evaluated by two-dimensional and speckle-tracking echocardiography and compared before and 1 year after surgery. After septal myectomy, LA volume index (58.1 ± 18.3 vs. 45.3 ± 14.6 mL/m2 , P = 0.001) decreased significantly. As LV end-systolic dimension increased after surgery, the LV ejection fraction decreased (73.8 ± 6.7 vs. 62.9 ± 8.3%, P < 0.001). LA strain (24.4 ± 9.3 vs. 30.5 ± 13.6%, P = 0.004) improved after septal myectomy, but LV global longitudinal strain deteriorated (-12.6 ± 3.6 vs. -11.6 ± 4.3%, P = 0.033), mainly related to worsening non-septal longitudinal strain (-14.4 ± 4.3 vs. -10.9 ± 8.4%, P = 0.005).

Conclusions: As haemodynamic loads due to LV outflow tract obstruction was relieved through surgical septal reduction therapy in patients with symptomatic obstructive HCM, there was a significant reduction in LA volume and restoration of LA mechanical dysfunction. However, LV mechanical dysfunction deteriorated even after surgical septal reduction therapy.

Keywords: Hypertrophic cardiomyopathy; Myocardial function; Septal reduction therapy.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Assessment of LA and LV mechanical function: (A) LA strain (B) LV longitudinal strain.
Figure 2
Figure 2
Echocardiographic parameters of the LA and LV before and 1 year after septal myectomy: (A) LA volume index (B) LA strain (C) LVEF (D) LV strain.
Figure 3
Figure 3
Simple correlation analysis between QRS widening and myocardial variables: (A) Postoperative QRS duration and change of LA volume index (B) Change of QRS duration and change of LA volume index (C) Postoperative QRS duration and change of LVEF (D) Change of QRS duration and change of LVEF.
See this image and copyright information in PMC

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