Contemporary insights into prognostic assessment and therapy in patients with hypertrophic obstructive cardiomyopathy

Cheng-Han Lee, Ping-Yen Liu, Liang-Miin Tsai

Research output: Contribution to journalArticle

Abstract

Hypertrophy cardiomyopathy (HCM) is a relatively complex and genetic associated cardiac disease with the prevalence rate of 0.2% in the general population. HCM has a great heterogeneity of morphologic, functional, and clinical features. Pathophysiologic presentations of this disorder include hyperdynamic systolic contraction, impaired left ventricular diastolic function, myocardial ischemia, and arrhythmia. HCM manifests as a predominantly non-obstructive disease with only about 25% of the patients demonstrate a sizable pressure gradient of left ventricular outflow tract (LVOT). Pharmacologic therapy including beta-adrenergic-blocking agents and verapamil remains the primary means to improve diastolic filling and possibly reduce pressure gradient of LVOT in patients with HOCM. In addition, invasive intervention to abolish the outflow gradient has been considered for only the minority of patients (about 5%) who have both marked outflow obstruction and refractory congestive heart failure unresponsive to medical therapy. Over four decades, surgical septal myotomy-myetomy has been successfully applied to treat these drug-refractory patients with 90% clinically successful rate. Since the mid-1980s, the dual-chamber pacing has been suggested as an alternative to surgery for HOCM. With recent and more convincingly controlled studies showing that dual-chamber pacing decreased only about 25% of outflow gradient and varied among patients. With advanced improvement in experience, there has been an estimated more than 3000 percutaneous transluminal septal myocardial ablation (PTSMA) procedures performed worldwide. PTSMA can reduce the LVOT gradient successfully in about 90% of treated patients. With rare complications such as complete AV block and possible injury to left anterior descending artery, PTSMA seems to be a less invasive and similar effect of treatment as surgical intervention.

Original languageEnglish
Pages (from-to)189-198
Number of pages10
JournalJournal of Internal Medicine of Taiwan
Volume15
Issue number5
Publication statusPublished - 2004 Dec 1

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Hypertrophic Cardiomyopathy
Cardiomyopathies
Hypertrophy
Therapeutics
Pressure
Adrenergic beta-Antagonists
Atrioventricular Block
Verapamil
Left Ventricular Function
Myocardial Ischemia
Cardiac Arrhythmias
Heart Diseases
Heart Failure
Arteries
Wounds and Injuries
Pharmaceutical Preparations
Population

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

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abstract = "Hypertrophy cardiomyopathy (HCM) is a relatively complex and genetic associated cardiac disease with the prevalence rate of 0.2{\%} in the general population. HCM has a great heterogeneity of morphologic, functional, and clinical features. Pathophysiologic presentations of this disorder include hyperdynamic systolic contraction, impaired left ventricular diastolic function, myocardial ischemia, and arrhythmia. HCM manifests as a predominantly non-obstructive disease with only about 25{\%} of the patients demonstrate a sizable pressure gradient of left ventricular outflow tract (LVOT). Pharmacologic therapy including beta-adrenergic-blocking agents and verapamil remains the primary means to improve diastolic filling and possibly reduce pressure gradient of LVOT in patients with HOCM. In addition, invasive intervention to abolish the outflow gradient has been considered for only the minority of patients (about 5{\%}) who have both marked outflow obstruction and refractory congestive heart failure unresponsive to medical therapy. Over four decades, surgical septal myotomy-myetomy has been successfully applied to treat these drug-refractory patients with 90{\%} clinically successful rate. Since the mid-1980s, the dual-chamber pacing has been suggested as an alternative to surgery for HOCM. With recent and more convincingly controlled studies showing that dual-chamber pacing decreased only about 25{\%} of outflow gradient and varied among patients. With advanced improvement in experience, there has been an estimated more than 3000 percutaneous transluminal septal myocardial ablation (PTSMA) procedures performed worldwide. PTSMA can reduce the LVOT gradient successfully in about 90{\%} of treated patients. With rare complications such as complete AV block and possible injury to left anterior descending artery, PTSMA seems to be a less invasive and similar effect of treatment as surgical intervention.",
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