Assessment of right ventricular mechanics before and after surgical myectomy in patients with hypertrophic obstructive cardiomyopathy, using two-dimension speckle tracking echocardiography

4^th Global Summit on Heart Diseases

March 15-16, 2019 Singapore

Mohamed Ahmed Ezzat, Hala Mahfouz Badran ,Ghada Soltan and Magdi H Yacoub

Cardiology Department Menoufiya University, Egypt, 

The BAHCM National Program, Egypt,

Imperial College, London, UK

Scientific Tracks Abstracts: J Cardiovasc Dis Diagn

Abstract :

Methods: 25 HCM patients, 68% males with mean age (34.5±12 years) were examined before and within two months after surgical myectomy using VVI. In addition to conventional echocardiographic parameters, peak systolic strain (εsys), strain rate (SR) and time to peak εsys (TTP) of regional RV free wall (RVFW) & septal walls were analyzed in longitudinal (long) directions from apical four chamber view and their (Î?)changes were calculated. Similar parameters were quantified in LV from apical 2&4 CH views. Intra-V-delay was defined as SD of TTP and inter-V dyssynchrony was estimated from TTP difference between the most delayed LV segment & RVFW.

Results: All study patients showed improvement of their functional class from NYHA class III to class I and reduction of LVOT gradient to below 20 mmHg except one patient who had 30 mmHg gradients at rest. There was significant reduction of septal thickness, left atrial diameter& volume, LVOT gradient, LVMI, severity of mitral regurgitation, tricuspid annular velocities (P<.0001), RV diameter (P<.02) and increase in LV internal dimensions (P<.001) post myectomy. However, there was significant reduction of RV and LV systolic mechanics; RV global εsys % (from -16.1±4.4 to -12.9±2.9, P<.0001) and LV global εsys %: from -11.6±2.8 to -9.4±2.2%, P<.0001) respectively. The magnitude of reduction of RV strain (Î? RV εsys%, Î? SRsys) was directly correlated LV maximal wall thickness(r=.46, P<.01) and Î?RV dyssynchrony (TTP-SD), (r=.4, P<.05) and negatively correlated to age (r=-.46, P<.02), pre-op RV SRsys (r=-.52, P<.01) and pre-op LV EF% (r=-.43, P<.03). Meanwhile the reduction in RV diastolic mechanics: Î? RV SRe & SRa were directly correlated to PAP and LVOT gradient before surgery(r=.62, P<.002).

Conclusion: Despite improvement of patient functional status and reduction LVOT gradient, RV mechanics shows further deterioration after surgical myectomy. The magnitude of reduction is modestly related to cardiac phenotype and pre-op mechanical function.

Biography :

Mohamed Ahmed Ezzat Enait is a faculty at Cardiology Department Menoufiya University, Egypt

E-mail: ebnezat@gmail.com