| Comparison of dual-chamber pacing versus septal myectomy for the treatment of patients with hypertrophic obstructive cardiomyopathy: a comparison of objective hemodynamic and exercise end points. | |
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MedLine Citation:
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PMID: 10400010 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The purpose of this study was to compare the treatment effects of septal myectomy with dual-chamber pacing in patients with hypertrophic obstructive cardiomyopathy (HOCM). BACKGROUND: The optimal treatment for symptomatic patients with drug-refractory HOCM is unknown. Both dual-chamber pacing and surgical myectomy may result in subjective symptom improvement. However, no direct comparisons with objective end points have been reported. METHODS: Thirty-nine patients with symptomatic HOCM were analyzed in this concurrent cohort study. Twenty patients underwent surgical myectomy, and 19 received dual-chamber pacemakers based on patient preference. These patients had prospective baseline and follow-up evaluations including physician assessment, echocardiography and standardized metabolic treadmill exercise testing. RESULTS: Baseline symptom status, left ventricular outflow tract gradients, exercise times and maximal oxygen consumption peak were similar between the two groups. Left ventricular outflow gradient was reduced from 76+/-57 to 9+/-17 mm Hg (p = 0.0001) after myectomy, and from 77+/-61 to 55+/-39 mm Hg (p = 0.07) after pacing (p = 0.02 for comparison with myectomy). Ninety percent of myectomy patients experienced symptomatic improvement as compared with 47% in the pacing group. Exercise duration increased significantly from 6.6+/-2.8 to 8.7+/-3.0 min (p = 0.0003) after myectomy compared with a change from 6.4+/-2.1 to 7.0+/-2.2 min (p = NS) in the pacing group. Maximal oxygen consumption increased from 19.4+/-6.4 to 22.2+/-6.5 ml/kg/min after myectomy (p = 0.004), whereas the pacing group did not experience any significant change (19.6+/-6.5 vs. 20.1+/-6.5 ml/kg/min, p = NS). CONCLUSIONS: Surgical myectomy and dual-chamber pacing improve subjective measures of functional status in patients with symptomatic HOCM. In this nonrandomized study, myectomy offered greater reduction in left ventricular outflow tract gradients and larger improvements in objective measures of patient symptoms and functional status when compared with dual-chamber pacing. |
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Authors:
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S R Ommen; R A Nishimura; R W Squires; H V Schaff; G K Danielson; A J Tajik |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 34 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1999 Jul |
Date Detail:
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Created Date: 1999-07-30 Completed Date: 1999-07-30 Revised Date: 2008-08-22 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 191-6 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Pacing, Artificial / methods* Cardiomyopathy, Hypertrophic / physiopathology, therapy* Exercise Test Exercise Tolerance Female Heart Septum / surgery* Hemodynamics Humans Male Middle Aged Oxygen Consumption Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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