Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: one-year follow-up

OBJECTIVE The objective of this study is to evaluate the one-year outcome of the first 50 patients who underwent nonsurgical septal reduction for symptomatic hypertrophic obstructive cardiomyopathy at our institution. BACKGROUND Left ventricular outflow tract obstruction is an important determinant...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2000-09, Vol.36 (3), p.852-855
Main Authors: Lakkis, Nasser M, Nagueh, Sherif F, Dunn, J.Kay, Killip, Donna, Spencer, William H
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Cardiomyopathy, Hypertrophic - complications
Cardiomyopathy, Hypertrophic - diagnostic imaging
Cardiomyopathy, Hypertrophic - mortality
Cardiomyopathy, Hypertrophic - therapy
Complementary Therapies - methods
Diseases of the cardiovascular system
Echocardiography, Doppler
Ethanol - therapeutic use
Female
Follow-Up Studies
Heart Septum - drug effects
Humans
Injections
Male
Medical sciences
Middle Aged
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Ventricular Outflow Obstruction - etiology
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Summary:OBJECTIVE The objective of this study is to evaluate the one-year outcome of the first 50 patients who underwent nonsurgical septal reduction for symptomatic hypertrophic obstructive cardiomyopathy at our institution. BACKGROUND Left ventricular outflow tract obstruction is an important determinant of clinical symptoms in patients with hypertrophic obstructive cardiomyopathy. Nonsurgical septal reduction is a new therapy that has been shown to result in left ventricular outflow tract gradient reduction and resolution of symptoms immediately after the procedure and on midterm follow-up. METHODS Fifty patients with hypertrophic obstructive cardiomyopathy who underwent nonsurgical septal reduction at our institution and completed 1-year follow-up are described. Complete history, physical examination, two-dimensional echocardiography with Doppler and exercise treadmill testing have been analyzed. RESULTS The mean age of the study group was 53 ± 17 years. All patients had refractory symptoms before enrollment. Ninety-four percent had class III or IV New York Heart Association class symptoms at baseline compared to none at 1 year (p < 0.001). The exercise duration increased by 136 s at 1 year (p < 0.021). Only 20% of patients were either receiving beta-blockers or calcium-channel blockers on follow-up. The resting left ventricular outflow tract gradient decreased from 74 ± 23 mm Hg to 6 ± 18 mm Hg (p < 0.01) and from 84 ± 28 mm Hg to 30 ± 33 mm Hg (p < 0.01) in patients with dobutamine-provoked gradient at one year. These changes are associated with decreased septal thickness and preserved systolic function. CONCLUSION Nonsurgical septal reduction therapy is an effective therapy for symptomatic patients with hypertrophic obstructive cardiomyopathy with persistence of the favorable outcome up to one year after the procedure.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(00)00767-1