Treatment strategies and efficacy evaluation of hypertrophic obstructive cardiomyopathy

doi:10.3877/cma.j.issn.2095-6568.2025.03.005

Abstract

Abstract:

Objective

To summarize the clinical experience of treating patients with hypertrophic obstructive cardiomyopathy (HOCM) in single center.

Methods

This retrospective study analyzed the data of patients with HOCM, characterized by a left ventricular outflow tract peak gradient (LVOTPG) ≥ 50 mmHg, who were treated at The First Affiliated Hospital of Soochow University between January 2020 and December 2022. Based on the different treatment methods received, patients were divided into three groups: the percutaneous elndocardial septum radiofrequency ablation (PESA) group, the modified Morrow group, and the medication-only group. Left ventricular outflow tract pressure gradient (LVOTPG), interventricular septal thickness (IVS), left ventricular ejection fraction (LVEF), left ventricular end-diastolic internal diameter (LVEDD), and pulmonary artery systolic pressure (PASP) among the three groups after 12 months of treatment were compared. Additionally, operation time, hospital days, incidence of postoperative arrhythmias, and pacing percentage between the PESA and modified Morrow groups were assessed.

Results

After 12 months, the PESA and modified Morrow groups showed reductions in LVOTPG at rest and after the Valsalva by (39.29±18.28) mmHg, (50.00±21.23) mmHg, and (69.29±20.73) mmHg and (99.79±23.82) mmHg (P=0.001), respectively, while the medication-only group showed increases of (13.43±13.11) mmHg (P=0.002) and (17.36±14.68) mmHg (P=0.001). Regarding IVS, the PESA and modified Morrow groups showed decreases of (1.07±2.95) mm (P=0.433) and (2.85±3.13) mm (P=0.005), respectively, whereas the medication-only group showed an increase of (1.14±1.51) mm (P=0.014). Additionally, LVEF improved by (5.64±5.37)% (P=0.002) in the PESA group and (0.93±5.65)% (P=0.549) in the medication-only group, while the modified Morrow group showed a decline of (1.43±4.97)% (P=0.302). Changes in LVEDD included decreases of (1.21±4.76) mm (P=0.357) in the PESA group and (0.71±4.46) mm (P=0.560) in the modified Morrow group, while the medication-only group exhibited an increase of (1.29±4.08) mm (P=0.260). PASP of the PESA and modified Morrow groups declined 10.00(5.75, 17.25) mmHg (P=0.001) and 7.50(5.50, 14.00) mmHg (P=0.002), respectively, while PASP of the medication-only group increased 6.00(2.00, 11.50) mmHg (P=0.012). No patients in the PESA group had severe arrhythmia after the operation. However, in the Morrow group, three patients received pacemaker implantation due to third-degree atrioventricular block. Significantly, the operation time and hospital days of the PESA group were notably shorter than those of the Morrow group.

Conclusion

Both the PESA and modified Morrow procedure can improve hemodynamic indexes and cardiac function of HOCM patients. However, PESA has the advantages of less trauma, no new postoperative arrhythmias, and shorter operation and hospitalization times, making it another effective treatment option besides surgical intervention for HOCM patients who do not respond well to medication treatment.

Key words: Cardiomyopathy, hypertrophic, Obstructive cardiomyopathy, percutaneous endocardial septum radiofrequency ablation, Modified Morrow procedure, Left ventricular outflow tract peak gradient, Left ventricular ejection fraction

Ningning Zheng, Yongbing Fu, Feng Xue, lin Ling, Mingzhu Xu, Tingbo Jiang. Treatment strategies and efficacy evaluation of hypertrophic obstructive cardiomyopathy[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2025, 13(03): 156-163.

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Figures/Tables 6

References 23

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基线特征	PESA组	改良Morrow组	单纯药物组
例数	14	14	14
年龄（岁，x±s）	57.35±7.02	60.50±6.55	55.28±11.20
男［例（%）］	9（64.29）	8（57.14）	8（57.14）
高血压［例（%）］	6（42.86）	6（42.86）	5（35.71）
糖尿病［例（%）］	2（14.29）	3（21.43）	3（21.43）
心功能（NYHA分级）［例（%）］
Ⅰ/Ⅱ级	0	0	11（78.57）
Ⅲ级	10（71.43）	11（78.57）	3（21.43）
Ⅳ级	4（28.57）	3（21.43）	0
二尖瓣反流［例（%）］
轻度	8（57.14）	7（50.00）	8（57.14）
中度	6（42.86）	6（42.86）	3（21.43）
重度	0	1（7.14）	0
LVOTPG（mmHg，x±s）
静息	82.93±24.12^a	83.36±18.71^a	57.43±26.27
Valsalva动作后	107.00±24.94^a	119.21±21.57^a	78.00±24.07
服用药物［例（%）］
β受体阻滞剂	12（85.71）	13（92.86）	14（100.00）
非二氢吡啶类钙通道阻滞剂	2（14.29）	4（28.57）	2（14.29）

基线特征	PESA组	改良Morrow组	单纯药物组
例数	14	14	14
年龄（岁，x±s）	57.35±7.02	60.50±6.55	55.28±11.20
男［例（%）］	9（64.29）	8（57.14）	8（57.14）
高血压［例（%）］	6（42.86）	6（42.86）	5（35.71）
糖尿病［例（%）］	2（14.29）	3（21.43）	3（21.43）
心功能（NYHA分级）［例（%）］
Ⅰ/Ⅱ级	0	0	11（78.57）
Ⅲ级	10（71.43）	11（78.57）	3（21.43）
Ⅳ级	4（28.57）	3（21.43）	0
二尖瓣反流［例（%）］
轻度	8（57.14）	7（50.00）	8（57.14）
中度	6（42.86）	6（42.86）	3（21.43）
重度	0	1（7.14）	0
LVOTPG（mmHg，x±s）
静息	82.93±24.12^a	83.36±18.71^a	57.43±26.27
Valsalva动作后	107.00±24.94^a	119.21±21.57^a	78.00±24.07
服用药物［例（%）］
β受体阻滞剂	12（85.71）	13（92.86）	14（100.00）
非二氢吡啶类钙通道阻滞剂	2（14.29）	4（28.57）	2（14.29）

项目	PESA组	改良Morrow组	单纯药物组
静息（mmHg，x±s）
治疗前	82.93±24.12^a	83.36±18.71^a	57.43±26.27
治疗后	43.64±23.27	14.57±6.25	70.86±25.07
P值	0.001	0.001	0.002
差值（对治疗前）	39.29±18.28^ab	69.29±20.73^a	13.43±13.11
Valsalva动作后（mmHg，x±s）
治疗前	107.00±24.94^a	119.21±21.57^a	78.00±24.07
治疗后	56.50±18.78	19.43±9.37	95.36±19.72
P值	0.001	0.001	0.001
差值（对治疗前）	50.00±21.23^ab	99.79±23.82^a	17.36±14.68

项目	PESA组	改良Morrow组	单纯药物组
静息（mmHg，x±s）
治疗前	82.93±24.12^a	83.36±18.71^a	57.43±26.27
治疗后	43.64±23.27	14.57±6.25	70.86±25.07
P值	0.001	0.001	0.002
差值（对治疗前）	39.29±18.28^ab	69.29±20.73^a	13.43±13.11
Valsalva动作后（mmHg，x±s）
治疗前	107.00±24.94^a	119.21±21.57^a	78.00±24.07
治疗后	56.50±18.78	19.43±9.37	95.36±19.72
P值	0.001	0.001	0.001
差值（对治疗前）	50.00±21.23^ab	99.79±23.82^a	17.36±14.68

项目	PESA组	改良Morrow组	单纯药物组
IVS（mm，x±s）
治疗前	16.64±3.95	17.57±3.11	15.79±3.47
治疗后	15.57±3.90	14.71±2.95	16.93±4.18
P值	0.433	0.005	0.014
差值（对治疗前）	1.07±2.95	2.85±3.13^a	1.14±1.51
LVEF（%，x±s）
治疗前	64.64±5.58	66.00±5.11	65.64±5.18
治疗后	70.29±2.87	64.57±4.13	66.57±2.74
P值	0.002	0.302	0.549
差值（对治疗前）	5.64±5.37^a，b	1.43±4.97	0.93±5.65
LVEDD（mm，x±s）
治疗前	47.79±3.60	48.43±4.40	45.79±4.25
治疗后	49.00±3.94	47.71±6.00	47.07±4.83
P值	0.357	0.560	0.260
差值（对治疗前）	1.21±4.76	0.71±4.46	1.29±4.08
PASP［mmHg，M（Q₁，Q₃）］
治疗前	35.50（32.00，42.25）^a	30.00（27.00，38.00）	24.50（20.00，35.25）
治疗后	26.50（23.75，28.00）	23.00（21.00，26.50）	32.50（27.25，38.25）
P值	0.001	0.002	0.012
差值（对治疗前）	-10.00（-17.25，-5.75）^a	-7.50（-14.00，-5.50）^a	6.00（2.00，11.50）

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