Midterm Outcome After Septal Myectomy and Medical Therapy in Mildly Symptomatic Patients With Hypertrophic Obstructive Cardiomyopathy

Jiejun Sun; Lin Liang; Peijin Li; Tengyong Jiang; Xianpeng Yu; Changwei Ren; Ran Dong; Jiqiang He

doi:10.3389/fcvm.2022.855491

Midterm Outcome After Septal Myectomy and Medical Therapy in Mildly Symptomatic Patients With Hypertrophic Obstructive Cardiomyopathy

Front Cardiovasc Med. 2022 Mar 25:9:855491. doi: 10.3389/fcvm.2022.855491. eCollection 2022.

Authors

Jiejun Sun¹, Lin Liang², Peijin Li¹, Tengyong Jiang¹, Xianpeng Yu¹, Changwei Ren², Ran Dong², Jiqiang He¹

Affiliations

¹ Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
² Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.

Abstract

Objective: The purpose of this study was mainly to determine the midterm outcome of septal myectomy (SM) and medical therapy (MT) in mildly symptomatic patients (NYHA class II) with hypertrophic obstructive cardiomyopathy (HOCM).

Methods: The study cohort consisted of 184 mildly symptomatic patients with HOCM evaluated in Beijing Anzhen Hospital, Capital Medical University between March 2001 and December 2017, including 82 patients in the SM group and 102 patients in the MT group. Overall survival and HCM-related survival were mainly observed.

Results: The average follow-up time was 5.0 years. Compared to patients accepting MT, patients treated with SM were associated with comparable overall survival (96.5% and 93.1% vs. 92.9% and 83.0% at 5 and 10 years, respectively; P = 0.197) and HCM-related survival (98.7% and 98.7% vs. 94.2% and 86.1% at 5 and 10 years, respectively; P = 0.063). However, compared to MT, SM was superior at improvement of NYHA class (1.3 ± 0.6 vs. 2.1 ± 0.5, P < 0.001) and mean reduction of resting left ventricular outflow (LVOT) gradient (78.5 ± 18.6% vs. 28.3 ± 18.4%, P < 0.001). Multivariate analysis suggested that resting LVOT gradient in the last clinical examination was an independent predictor of all-cause mortality (HR = 1.017, 95%CI: 1.000-1.034, P = 0.045) and HCM-related mortality (HR = 1.024, 95%CI: 1.005-1.043, P = 0.012) in the entire cohort.

Conclusion: Compared with MT, SM had comparable overall survival and HCM-related survival in mildly symptomatic HOCM patients, but SM had advantages on improving clinical symptoms and reducing resting LVOT gradient. Resting LVOT gradient in the last clinical examination was an independent predictor of all-cause mortality and HCM-related mortality.

Keywords: hypertrophic obstructive cardiomyopathy (HOCM); medical therapy (MT); mild symptom; outcome; septal myectomy.