Dynamic Changes of Distinct Compartmental LV Remodeling Following Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy.

IF 7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2025-08-27 DOI:10.1161/CIRCIMAGING.125.018131

Xinyi Luo, Guanyu Lu, Ziyu Liu, Yinzhu Chen, Jiehao Ou, Hongxiang Wu, Wei Zhu, Rui Chen, Huiming Guo, Hui Liu, Yuelong Yang

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引用次数: 0

Abstract

Background: In hypertrophic obstructive cardiomyopathy, left ventricular mass index (LVMi) regresses following septal myectomy, but the specific dynamics, mechanisms (involving cellular and extracellular compartments), and related factors remain unclear.

Methods: This prospective study included hypertrophic obstructive cardiomyopathy patients who underwent septal myectomy. Cardiac magnetic resonance imaging was performed preoperatively and at 6, 12, and 24 months postoperatively. LVMi, indexed cellular volume, and indexed extracellular volume were analyzed using repeated measures ANOVA. Factors associated with LVMi regression, postoperatively, were identified using linear regression.

Results: The study included 27 patients (53.70±13.85 years; 17 female). LVMi significantly decreased from 105.76±25.22 g/m², preoperatively, to 82.52±25.90 g/m² at 6 months, postoperatively, further declining to 78.86±24.73 g/m² at 12 months and 76.22±23.93 g/m² at 24 months (P<0.05). The average percent decrease in LVMi from baseline was 22.97% at 6 months, 26.26% at 12 months, and 28.58% at 24 months postoperatively. This regression is primarily driven by indexed cellular volume regression (23.70%), with a smaller reduction in the indexed extracellular volume (18.40%) in the first 6 months. Both compartments exhibited sustained reductions through 12 months. But from 12 to 24 months, only indexed extracellular volume continued to decline (from 22.13±6.76 to 20.89±6.25 mL/m²; P<0.001). Greater left ventricular outflow tract pressure gradient reduction (β=0.157; P=0.001) was associated with LVMi regression after septal myectomy.

Conclusions: In patients with hypertrophic obstructive cardiomyopathy postseptal myectomy, early LVMi reduction involves both cellular and extracellular compartments, with slower reduction from 12 to 24 months, mainly driven by the extracellular component. This demonstrates rapid myocardial adaptability to afterload relief, with slower extracellular matrix remodeling. Greater left ventricular outflow tract pressure gradient reduction was associated with greater LVMi regression after surgery.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: CTR2100043699.

查看原文本刊更多论文

肥厚性梗阻性心肌病室间隔肌切除术后不同室间室左室重构的动态变化。

背景：肥厚性梗阻心肌病患者，左心室质量指数（LVMi）在室间隔切除术后有所下降，但具体的动力学、机制（包括细胞和细胞外室）和相关因素尚不清楚。方法：这项前瞻性研究纳入了接受隔肌切除术的肥厚性阻塞性心肌病患者。术前、术后6、12、24个月分别行心脏磁共振成像。LVMi、指数化细胞体积和指数化细胞外体积采用重复测量方差分析。术后LVMi回归相关因素采用线性回归确定。结果：共纳入27例患者（53.70±13.85岁，女性17例）。LVMi由术前的105.76±25.22 g/m2显著下降至6个月时的82.52±25.90 g/m2，术后进一步下降至12个月时的78.86±24.73 g/m2和24个月时的76.22±23.93 g/m2 (P2， PP=0.001)，与室间隔肌切除术后LVMi的消退相关。结论：在肥厚性梗阻性心肌病患者中，间隔肌切除术后的早期LVMi降低涉及细胞和细胞外腔室，在12 - 24个月期间降低较慢，主要由细胞外成分驱动。这表明心肌对负荷减轻的适应性很快，细胞外基质重构较慢。手术后左室流出道压力梯度降低越大，左室心肌梗死消退越大。注册：网址：https://www.clinicaltrials.gov；唯一标识符：CTR2100043699。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.