Author + information
- Mike Saji Makoto Suzuki,
- Itaru Takamisawa,
- Mitsuhiko Ohta,
- Keitaro Mahara,
- Kanki Inoue,
- Tetsuya Tobaru,
- Nobuo Iguchi,
- Morimasa Takayama and
- Hitonobu Tomoike
Clinical feature of refractory hypertrophic obstructive cardiomyopathy (HOCM) with pulmonary hypertension (PH) remains unclear.
From December 2007 to May 2011, total of 92 consecutive patients (57 female, 35 male; mean age 61±16years) with refractory symptomatic HOCM who underwent percutaneous alcohol septal ablation (PTSMA) were studied. After divided patients into the two groups according to the presence or not of PH defined as an increase in mean pulmonary artery pressure (PAP) more than 25mmHg assessed by right heart catheterization, hemodynamic characteristics were evaluated before and after PTSMA.
Thirty two patients (35% of total) were PH (PAP, 30±6mmHg) with an increase in pulmonary wedge pressure (PWP, 21±5mmHg), indicating post-capillary PH. Transthoracic echocardiographical findings at 12 months follow up showed thickness of intraventricular septum was significantly decreased in both group from 17.3±2.9mm to 15.6±3.8mm with PH (p=0.001) and from 16.2±4.3mm to 14.6±4.1mm without PH (p<0.001). Mitral regurgitation was also significantly decreased from 2.1±0.9 to 1.3±0.5 with PH (p<0.001) and from 1.9±0.8 to 1.3±0.7 without PH (p<0.001). In patients without PH, PTSMA markedly decreased the maximal left ventricular outflow tract gradients (LVOTG) from 124±45mmHg to 41±35mmHg (p<0.001) and increased cardiac index (CI) from 3.0±0.5 to 3.4±0.7 L/m2. In those with PH, PTSMA also improved LVOTG from 128±44mmHg to 53±35mmHg (p<0.001), but not CI (3.3±0.7 vs. 3.5±0.7 L/m2, p=0.343). Further, PTSMA significantly decreased pulmonary vascular resistance in patients without PH (107±48 to 92±45 dynes*sec*cm5, p=0.016), but not in those with PH (147±53 to 131±49 dynes*sec*cm5, p=0.133). Based on the cut-off transpulmonary pressure gradient of 12mmHg, 3 patients (9% of PH) applied to out of proportion in post-capillary PH.
The present study may provide new insights into pending clinical feature in patients with refractory symptomatic HOCM with PH.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Hypertrophic Cardiomyopathy: Variants and Outcomes
Abstract Category: 23. Pericardial/Myocardial Disease
Presentation Number: 1122-147
- 2013 American College of Cardiology Foundation