CONTEMPORARY METHODS FOR MYOCARDIAL FUNCTION EVALUATION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY BEFORE AND AFTER SURGICAL TREATMENT

Aim. To invent and qualify a diagnostic algorhythm for systolic and diastolic myocardium function evaluation in the left ventricle in patients with hypertrophic cardiomyopathy before and after surgical treatment.

Material and methods. Totally 88 patients included, 54 with hypertrophic cardiomyopathy (27 male, 27 female) with median age 59±13 y.o. Obstructive type of HCMP was found in 41 pt. Transluminal ethanol-based septal ablation was done for 17 pts. Myoectomy/myotomy was done for 11 pts. The control consisted of 34 healthy volunteers with medial age 36,7±8,3 y.o.: 24 men (70%) and 10 women (30%). To everyone included the echocardiography was performed using the Vivid E9 machine (GE, USA) with multifrequent sensor 3,5-5,0 MHz. The data was then processed by computer-based Multivox program. The "flow-volume" loop of the single cardiac cycle was reconstructed using numeric data for everyone of patients; also the data on myocardium segment shift were used.

Results. The parameters of volume change rapidity (dVol/dt (s, d)) and the parameters of systolic and diastolic summes of normal velocities (I Vr (s, d)) serve as strict independent predictors of the impaired systolic and diastolic function of LV myocardium and also as early markers of LV disordered function recovery in HCMP after surgical treatment. The markers of long axis diastolic shift (dL/dt (d)) and diastolic volume changes (dVol/dt (d)) are the most accurate in prediction of left ventricle changes after surgical treatment in HCMP

Conclusion. We have invented a novel and original approach to the evaluation of systolic and diastolic myocardial function in patients with obstructive type hypertrophic cardiomyopathy before and after surgical treatment using our own algorhythm based on echocardiographical measurements of myocardium shift rapidity.

1. Maron MS, Olivotto I, Betocchi S, et al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J 2003; 348: 295-303.

2. Harris KM, Spirito P, Maron MS, et al. Prevalence, clinical profile, and significance of left ventricular remodeling in the end-stage phase of hypertrophic cardiomyopathy. Circulation 2006, 114: 216-25.

3. Kofflard MJM, et al. Hypertrophic cardiomyopathy in a large community based population: clinical outcome and identification of risk factors for sudden cardiac death and clinical deterioration. J Am Coll Cardiol 2003; 41: 987-93.

4. Ommen SR, Maron BJ, Olivio I, et al. Long-Term Effects of Surgical Septal Myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2005; 46: 15-22.

5. Sigwart U. Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet, 1995; Jul 22, 346 (8969): 211-4.

6. Sandrikov VA, Kulagina TYu, Van EYu, et al. "Flow-volume" loop in patients with aortic stenosis (1 message). Ultrasonic and functional diagnostics 2010; 6: 56-64. Russian (Сандриков В. А., Кулагина Т. Ю., Ван Е. Ю., и др. Диаграмма "поток-объем" у пациентов с аортальным стенозом (сообщение 1). 2010; 6: 56-64).

7. Van EYu, Kulagina TYu, Berezina EV, et al. Left Ventricle Systolic and Diastolic Function in Patients with Hypertrophic Cardiomyopathy. Ultrasonic and functional diagnostics 2013; 2: 28. Russian. (Ван Е. Ю., Кулагина Т. Ю., Березина Е. В.и др. Систолическая и диастолическая функция левого желудочка у пациентов с гипертрофической кардиомиопатией. Ультразвуковая и функциональная диагностика. 2013; 2: 28).