Abstract | OBJECTIVES: 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 to 18 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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Authors | P Boekstegers, P Steinbigler, A Molnar, M Schwaiblmair, A Becker, A Knez, R Haberl, G Steinbeck |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 38
Issue 3
Pg. 846-53
(Sep 2001)
ISSN: 0735-1097 [Print] United States |
PMID | 11527644
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Aged
- Cardiomyopathy, Hypertrophic
(complications, surgery)
- Electrophysiologic Techniques, Cardiac
- Ethanol
(administration & dosage)
- Exercise Test
- Female
- Heart Septum
(pathology, surgery)
- Hemodynamics
- Humans
- Infarction
(pathology)
- Male
- Middle Aged
- Pressure
- Quality of Life
- Ventricular Outflow Obstruction
(etiology, surgery)
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