CLINICAL STUDY
Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: one-year follow-up
Nasser M. Lakkis, MD, FACCa,
Sherif F. Nagueh, MD, FACCa,
J. Kay Dunn, PhDa,
Donna Killip, RNa and
William H. Spencer, III, MD, FACCa
a Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas, USA
Manuscript received November 10, 1998;
revised manuscript received February 1, 2000,
accepted April 14, 2000.
Reprint requests and correspondence: Dr. William H. Spencer, III, The Baylor Heart Clinic, 6550 Fannin, SM 1901, Houston, Texas 77030
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.
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Abbreviations and Acronyms
| | HOCM | = hypertrophic obstructive cardiomyopathy | | LVOT | = left ventricular outflow tract | | NSRT | = nonsurgical septal reduction therapy | | SAM | = systolic anterior motion |
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