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LEFT VENTRICULAR OUTFLOW GRADIENT REDUCTION IMPROVES EXERCISE CAPACITY IN PATIENTS WITH HYPERTROPHlC OBSTRUCTIVE CARDIOMYOPATHY.
W.Rużyłło, L.Chojnowska, M.Demkow, A.Witkowski, B.Kuśmierczyk-Droszcz, L.Rausińska, W.Piotrowski, M.Karcz, L.Małecka, J.Stępińska, W.Rydlewska-Sadowska.
National Institute of Cardiology, Warsaw, Poland.

Percutaneous transluminal septal myocardial ablation (PTSMA) is a new catheter technique used for the treatment of symptomatic patients (pts) with obstructive hypertrophic cardiomyopathy (HOCM). It has been reported that majority of pts have symptomatic improvement from a reduction of the left ventricular outflow (LVOT) gradient with PTSMA. However, exercise capacity response to LVOT gradient reduction has not been fully documented.
Aim of the study was to determine the 6-month clinical follow-up (F-U) with exercise capacity assessment in a group of patients treated with PTSMA.
Patients, methods: Twenty five pts, 15M, aged 49.3±13.1 yrs have been treated with PTSMA. All patients had echocardiographic evidence of LVOT obstruction, mean 84.54±31.38mmHg (ranged 30-148mmHg) and symptoms of dyspnoe (2.8±0.5 NYHA class, peak V02 14.8+/-4.1ml/kg/min) or angina. The pts were followed for 6 to 13 months (mos), mean 10.44±1.8mos. In all patients clinical examination with ECHO and symptom-limited treadmill exercise test were performed before PTSMA and at six month F-U. Eigthteen pts underwent simultaneous respiratory qas analysis (Vmax 29C Series Spectrometer, Sensor Medics, USA).
Results: Persistent LVOT gradient reduction (from 84.54±31.38 to 32.44±25.82mmHg p<0.0001) was seen in 23 of 25 pts. In 17 pts LVOT gradient reduced >=50% of baseline value (B). Twenty (80%) pts showed clinical improvement up to NYHA class 1.2±0.5 vs 2.8±0.5, p<0,0001, in other 5 pts functional status did not change. Clinical improvement was matched by improvements in objective measures of exercise capacity (EC) in these 17 pts in whom LVOT gradient reduced >= 50% of B: treadmil exercise time increased from 571.9±192.2 to 703.0±175.4 sek, p<0.005, peak V02 increased from 14.8±41 to 20.5±8.6ml/kg/min, p<0.05. Objective measures of EC did not change in those 6 pts in whom LVOT gradient reduction was less than 50% of B, as well as in both pts with no LVOT gradient reduction.
Conclusions: 1. Reduction in left ventricular outflow tract obstruction with PTSMA results in exercise capacity improvement with symptoms amelioration. 2. Correlation between the magnitude of outflow tract gradient reduction and objective measures of exercise capacity confirms the hemodynamic significance of LVOT obstruction in HOCM patients.


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