Published Online
on July 1, 2002

A more recent version of this article appeared on July 23, 2002

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Submitted on March 28, 2002
Revised on May 22, 2002
Accepted on May 23, 2002

Acute Effect of Nonsurgical Septal Reduction Therapy on Regional Left Ventricular Asynchrony in Patients With Hypertrophic Obstructive Cardiomyopathy

Tae-Ho Park MD, Nasser M. Lakkis MD, Katherine J. Middleton RCT, Jennifer Franklin RN, William A. Zoghbi MD, Miguel A. Quiñones MD, William H. Spencer III MD, and Sherif F. Nagueh MD^*

From the Section of Cardiology, Department of Medicine, Baylor College of Medicine, and the Methodist Hospital (K.J.M.), Houston, Texas.

^* To whom correspondence should be addressed. E-mail: sherifn{at}bcm.tmc.edu.

Background—Patients with hypertrophic obstructive cardiomyopathy have left ventricular (LV) diastolic dysfunction due, in part, to temporal heterogeneity in regional function. The acute effect of the relief of LV outflow tract obstruction is unknown. Therefore, we investigated the effects of nonsurgical septal reduction therapy (NSRT) on regional function.

Methods and Results—Twenty-two patients (aged 56±17 years) underwent echocardiographic examination, including tissue Doppler imaging, simultaneously with left heart catheterization before and after NSRT. LV regional function was assessed in 12 segments from which myocardial strain was obtained. Asynchrony was calculated as the coefficient of variation of the time interval from the QRS complex to the onset of expansion and to early diastolic strain. After NSRT, a significant reduction in LV outflow tract obstruction (from 57±5 to 12±3 mm Hg) occurred with shortening of the time constant of LV relaxation (71±4 to 61±3 ms; both P<0.05). The coefficient of variation of the time interval to onset of regional expansion decreased significantly and related well to the changes in the time constant of LV relaxation (r=0.81, P<0.01).

Conclusions—NSRT has a favorable effect on LV regional asynchrony, which accounts for the acute changes in LV relaxation.

Key words: cardiomyopathy • diastole • echocardiography • hemodynamics

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