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Left atrial remodeling postseptal myectomy for severe obstructive hypertrophic cardiomyopathy: Analysis by two‐dimensional speckle‐tracking echocardiography
Author(s) -
WeisslerSnir Adaya,
Hindieh Waseem,
Moravsky Gil,
RalphEdwards Anthony,
Williams Lynne,
Rakowski Harry,
Carasso Shemy
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14226
Subject(s) - medicine , cardiology , speckle tracking echocardiography , hypertrophic cardiomyopathy , cardiomyopathy , diastole , ejection fraction , heart failure , blood pressure
Background Septal myectomy relieves left ventricular outflow obstruction ( LVOTO ) and is associated with excellent long‐term outcomes. LVOTO is associated with diastolic dysfunction and increased left atrial ( LA ) size. We sought to investigate the changes in LA volumes and function postmyectomy and the association between these changes with clinical outcomes postmyectomy. Methods Sixty‐six hypertrophic cardiomyopathy patients undergoing myectomy were retrospectively studied. Preprocedural and 6‐ to 18‐month postmyectomy follow‐up transthoracic echocardiographic images were obtained. LA volumes and strain were assessed by two‐dimensional speckle‐tracking echocardiography. Results Left atrial volumes, that is, indexed maximal, minimal, and pre‐A volumes reduced postmyectomy, yet remained increased compared to controls (105.6 ± 34.5 mL vs 84.9 ± 26.7 mL, 45.2 ± 25.7 mL vs 35.4 ± 22.6 mL, 70.1 ± 31.4 mL vs 35.4 ± 22.6 mL, respectively, P < 0.05). The total emptying index did not improve postmyectomy and remained lower than controls (58.6 ± 12.4 vs 59.9 ± 12.8, P = NS ) whereas atrial contraction improved, yet did not normalize (active emptying index 36.1 ± 14.9 vs 41.1 ± 16.2, P < 0.05). The conduit volume remained reduced postmyectomy (18.6 ± 13.3 mL vs 16.6 ± 15.1 mL, P = NS ). LA strain also did not improve postmyectomy (26.8 ± 7.3 vs 28.5 ± 8.8, P = NS ). A multivariable logistic regression identified preprocedural E/e′ ratio and indexed maximal LA volume, as independent predictors for LA volume reduction ≥20% postmyectomy. During a mean follow‐up of 4.9 ± 2.3 years postmyectomy, 24.2% of the patients developed atrial fibrillation and <5% of patients were severely symptomatic. We found no associations between LA volumes/function and atrial fibrillation or symptoms postmyectomy. Conclusion Postmyectomy LA volumes decreased, and the contractile function improved. There was no association between LA volumes/function and clinical outcomes postmyectomy. Notably, the LA remained enlarged (though to a lesser degree) with reduced strain and emptying fraction, suggesting possible atrial myopathy.