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CLINICAL STUDIES

Changes in left ventricular filling and left atrial function six months after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy

^a Cardiology Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

Manuscript received December 31, 1998; revised manuscript received March 31, 1999, accepted June 23, 1999.

Reprint requests and correspondence: Sherif F. Nagueh, Cardiology Section, Baylor College of Medicine, 6550 Fannin, SM1246, Houston, Texas 77030
sherifn{at}bcm.tmc.edu

OBJECTIVES

The purpose of this study was to evaluate changes in left ventricular (LV) filling, left atrial (LA) volumes and function six months after nonsurgical septal reduction therapy (NSRT) for hypertrophic obstructive cardiomyopathy (HOCM).

BACKGROUND

Patients with HOCM frequently have enlarged left atria, which predisposes them to atrial fibrillation. Nonsurgical septal reduction therapy results in significant reduction in left ventricular outflow tract (LVOT) obstruction and symptomatic improvement. However, its effect on LV passive filling volume, LA volumes and function is not yet known.

METHODS

Thirty patients with HOCM underwent treadmill exercise testing as well as 2-dimensional and Doppler echocardiography before and six months after NSRT. Data included clinical status, exercise duration, LVOT gradient, mitral regurgitant (MR) volume, LV pre-A pressure and LA volumes. Left atrial ejection force and kinetic energy (KE) were computed noninvasively and were compared with 12 age-matched, normal subjects.

RESULTS

New York Heart Association (NYHA) class was lower and exercise duration was longer (p < 0.05) six months after NSRT. The LVOT gradient, MR volume and LV pre-A pressure were all significantly reduced. HOCM patients had larger atria, which had a higher ejection force and KE, compared with normal subjects (p < 0.01). After NSRT, LV passive filling volume increased (p < 0.01), whereas LA volumes, ejection force and KE decreased (p < 0.01). Reduction in LA maximal volume was positively related to changes in LV pre-A pressure (r = 0.8, p < 0.05) and MR volume (0.4, p < 0.05). Changes in LA ejection force were positively related to changes in LA pre-A volume (r = 0.7, p < 0.01) and KE (r = 0.81, p < 0.01). The increase in exercise duration paralleled the increase in LV passive filling volume (r = 0.85, p < 0.05).

CONCLUSIONS

Nonsurgical septal reduction therapy results in an increase in LV passive filling volume and a reduction in LA size, ejection force and KE.

Abbreviations and Acronyms   HCM = hypertrophic cardiomyopathy   HOCM = hypertrophic obstructive cardiomyopathy   KE = kinetic energy   LA = left atrial   LV = left ventricular   LVOT = left ventricular outflow tract   MR = mitral regurgitant   NSRT = nonsurgical septal reduction therapy   NYHA = New York Heart Association   RVOT = right ventricular outflow tract   TD = tissue Doppler

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