{"title":"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。","authors":"Xinyi Luo, Guanyu Lu, Ziyu Liu, Yinzhu Chen, Jiehao Ou, Hongxiang Wu, Wei Zhu, Rui Chen, Huiming Guo, Hui Liu, Yuelong Yang","doi":"10.1161/CIRCIMAGING.125.018131","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>The study included 27 patients (53.70±13.85 years; 17 female). LVMi significantly decreased from 105.76±25.22 g/m<sup>2</sup>, preoperatively, to 82.52±25.90 g/m<sup>2</sup> at 6 months, postoperatively, further declining to 78.86±24.73 g/m<sup>2</sup> at 12 months and 76.22±23.93 g/m<sup>2</sup> at 24 months (<i>P</i><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/m<sup>2</sup>; <i>P</i><0.001). Greater left ventricular outflow tract pressure gradient reduction (β=0.157; <i>P</i>=0.001) was associated with LVMi regression after septal myectomy.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: CTR2100043699.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018131"},"PeriodicalIF":7.0000,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dynamic Changes of Distinct Compartmental LV Remodeling Following Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy.\",\"authors\":\"Xinyi Luo, Guanyu Lu, Ziyu Liu, Yinzhu Chen, Jiehao Ou, Hongxiang Wu, Wei Zhu, Rui Chen, Huiming Guo, Hui Liu, Yuelong Yang\",\"doi\":\"10.1161/CIRCIMAGING.125.018131\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>The study included 27 patients (53.70±13.85 years; 17 female). LVMi significantly decreased from 105.76±25.22 g/m<sup>2</sup>, preoperatively, to 82.52±25.90 g/m<sup>2</sup> at 6 months, postoperatively, further declining to 78.86±24.73 g/m<sup>2</sup> at 12 months and 76.22±23.93 g/m<sup>2</sup> at 24 months (<i>P</i><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/m<sup>2</sup>; <i>P</i><0.001). Greater left ventricular outflow tract pressure gradient reduction (β=0.157; <i>P</i>=0.001) was associated with LVMi regression after septal myectomy.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: CTR2100043699.</p>\",\"PeriodicalId\":10202,\"journal\":{\"name\":\"Circulation: Cardiovascular Imaging\",\"volume\":\" \",\"pages\":\"e018131\"},\"PeriodicalIF\":7.0000,\"publicationDate\":\"2025-08-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCIMAGING.125.018131\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCIMAGING.125.018131","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Dynamic Changes of Distinct Compartmental LV Remodeling Following Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy.
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.
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.
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