Clinical value of 2D speckle tracking imaging in evaluating the effect of percutaneous intramyocardial septal radiofrequency ablation in patients with hypertrophic obstructive cardiomyopathy

Abstract

Purpose To explore the short‐term changes after percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in patients with hypertrophic obstructive cardiomyopathy (HOCM), using quantitative analysis of two‐dimensional speckle tracking imaging (2D‐STI). Methods This prospective self‐controlled study included 30 HOCM patients treated with PIMSRA. The study for each patient spanned over at least 1 year. Interventricular septal thickness and the left ventricular outflow tract peak pressure gradient (LVOT‐PG) were measured through echocardiography, and 2D‐STI was used to evaluate the left ventricular (LV) systolic function and synchrony. Cardiac function was assessed using the New York Heart Association's (NYHA) functional classification for cardiac disease, and through the serum levels of cardiac troponin I (cTnI) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). Biomarkers procollagen type I carboxy‐terminal propeptide (PICP) and matrix metalloproteinases‐2 (MMP‐2) were detected for noninvasive assessment of myocardial fibrosis. Results The patients' interventricular septal thickness, LVOT‐PG, NYHA class, and plasma PICP and MMP‐2 levels at the first month postoperatively were significantly lower than before operation (all P < .05). The 2D‐STI quantitative variables of LV systolic function and synchrony improved significantly (all P < .05). They improved further 1 year postoperatively (P < .01 or P < .001). Serum cTnI and NT‐proBNP levels increased 1 month postoperatively, but significantly decreased 1 year postoperatively (both P < .05). Pearson or Spearman correlation analysis showed that the improvement of interventricular septal thickness, LVOT‐PG, NYHA class, and the levels of cTnI, NT‐proBNP, PICP and MMP‐2, were in positive correlation with the restoration of LV systolic function and synchrony (P < .01 or P < .001). Conclusion The changes in 2D‐STI quantitative variables related to LV systolic function and synchrony are closely correlated with the improvement of cardiac function in HOCM patients after PIMSRA. These 2D‐STI variables can serve for objective, accurate, and noninvasive evaluation of the HOCM treatment.

Metalloproteinases and Hypertrophic Cardiomyopathy: A Systematic Review

“…Due to their strong molecular relationship with cardiac remodelling, MMP-2 and MMP-9 are still being studied. As confirmed by the present study, MMP-2 and MMP-9 are the most studied as biomarkers of cardiac remodelling [10,11,13,[15][16][17][18][19][20][21][22][23][24][25]. The heart's cardiomyocytes, fibroblasts, endothelial cells, and inflammatory cells can all make and secrete MMP-2.…”

“…A total of 20 relevant publications were retrieved for further assessment. Furthermore, 16 trials that enrolled a total of 892 participants met the inclusion criteria and were included in the systematic review [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Two review authors (F.J., G.F.S.)…”

“…Of the sixteen studies included, two were retrospective NRCTs (n = 95) [ 17 , 21 ], whereas the remaining fourteen were prospective observational NRCTs [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 18 , 19 , 20 , 22 , 23 , 24 , 25 ]. All studies included patients with HCM, but some better defined their population: two studies enrolled patient undergoing alcohol septal ablation (n = 85) [ 10 , 14 ], one study included patients submitted to percutaneous intramyocardial septal radiofrequency ablation [ 24 ], and two enrolled patients submitted to surgical myectomy (n = 107) [ 23 , 25 ].…”

Percutaneous Intramyocardial Septal Radiofrequency Ablation in Patients with Hypertrophic Cardiomyopathy – A Systematic Review and Meta-analysis

“…The initial search yielded 72 potential studies. After exclusions, 5 trials remained for analysis [1,3,4,7,8].…”

“…Diagnostic modalities include echocardiography, electrocardiogram (ECG), and cardiovascular magnetic resonance imaging (CMRI). Identi cation of the HCM phenotype can be made by family screening and genetic testing in affected individuals [3,4]. The treatment goals are to reduce the severity of symptoms and prevent sudden cardiac death, particularly in young adults.…”