CLINICAL STUDY: HYPERTROPHIC CARDIOMYOPATHY
Pressure-guided nonsurgical myocardial reduction induced by small septal infarctions in hypertrophic obstructive cardiomyopathy
Peter Boekstegers, MDa,
Peter Steinbigler, MDa,
Alexander Molnar, MDa,
Martin Schwaiblmair, MDa,
Alexander Becker, MDa,
Andreas Knez, MDa,
Ralph Haberl, MDa and
Gerhard Steinbeck, MDa
a Internal Medicine I, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
Manuscript received August 28, 2000;
revised manuscript received April 23, 2001,
accepted May 15, 2001.
Reprint requests and correspondence: Dr. Peter Boekstegers, Internal Medicine I, Klinikum Grosshadern, Ludwig-Maximilians-University, 81366 Munich, Germany
boekstegers{at}med1.med.uni-muenchen.de
OBJECTIVES
We sought to assess the safety and efficacy of pressure-guided nonsurgical myocardial reduction (NSMR) with the induction of small septal infarctions in patients with hypertrophic obstructive cardiomyopathy (HOCM).
BACKGROUND
Nonsurgical myocardial reduction has been shown to decrease left ventricular outflow tract (LVOT) obstruction and to improve symptoms in patients with HOCM. Infarct sizes differ considerably among studies published so far.
METHODS
In 50 patients, the LVOT gradient was invasively determined at the time of the intervention, four to six months (n = 49) and 12 to18 months (n = 25) after NSMR. New York Heart Association functional class and quality of life were assessed by using a standard questionnaire. Exercise capacity was tested by spiro-ergometry. Left ventricular (LV) mass was determined by electron beam computed tomography.
RESULTS
Small septal infarctions (mean creatine kinase value 413 ± 193 U/l) resulted in a sustained decrease in LVOT gradients, from 80 ± 33 to 18 ± 17 mm Hg after four to six months (p < 0.001, n = 49) and to 17 ± 15 mm Hg (p < 0.001, n = 25) after 12 to 18 months. Nonsurgical myocardial reduction was followed by a decrease in LV hypertrophy, which was associated with a sustained increase in exercise capacity, as well as improvement in quality of life.
CONCLUSIONS
Pressure-guided NSMR inducing small septal infarctions was sufficient to result in a sustained decrease in LVOT obstruction and to improve symptoms. The incidence of complications, such as complete heart block with necessary permanent pacemaker implantation (<10%), seems to be diminished by minimizing the infarct size.
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Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | CK | = creatine kinase | | HOCM | = hypertrophic obstructive cardiomyopathy | | LV | = left ventricle, left ventricular | | LVEDP | = left ventricular end-diastolic pressure | | LVH | = left ventricular hypertrophy | | LVOT | = left ventricular outflow tract | | NSMR | = nonsurgical myocardial reduction | | NYHA | = New York Heart Association |
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