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Dyssynchronization reduces dynamic obstruction without affecting systolic function in patients with hypertrophic obstructive cardiomyopathy: a pilot study

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Abstract

Dyssynchrony from biventricular pacing (BiV) can reduce dynamic obstruction in hypertrophic obstructive cardiomyopathy (HOCM), but its consequences on the left ventricular (LV) systolic function are unknown. We evaluate changes in LV systolic function and assess the effectiveness of BiV in HOCM. Thirteen patients with HOCM (55 [33/75] years, five males) received a BiV device and underwent 2D transthoracic echocardiography before the implantation and at 12 months follow-up. Global longitudinal and radial strain, and the timing of segmental displacement curves were measured by commercial speckle-tracking software to assess LV systolic function and dyssynchrony. Peak gradient in the LV outflow tract (LVOT) significantly decreased from 80 [51/100] to 30 [5/66] mmHg (p = 0.005). LV global strain was preserved from baseline to follow-up: 35.1 [20.2/43.8] % vs. 32.6 [27.1/44.1] %, p = NS (radial), and −16.6 [−19.1/−14.4] % vs. −15.7 [−17.0/−14.2] %, p = NS (longitudinal). Dyssynchrony analysis using displacement curves showed inversion of wall motion timing with earlier displacement of the lateral wall at follow-up only in patients with reduction in LVOT gradient. BiV reduces LVOT obstruction in patients with HOCM when dyssynchronization of LV motion and inversion of the timing of LV wall activation are reached. Notably, this does not lead to further deterioration of LV systolic function at mid-term follow-up.

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Abbreviations

AV:

Atrio-ventricular

BiV:

Biventricular pacing

HOCM:

Hypertrophic obstructive cardiomyopathy

LV:

Left ventricle

LVOT:

Left ventricle outflow tract

RV:

Right ventricle

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Acknowledgments

The authors acknowledge the Spanish Industrial and Technological Development Center (cvRemod-CEN-20091044), the Subprograma de Proyectos de Investigación en Salud, Instituto de Salud Carlos III, Spain (FIS-PI11/01709), the Plan Nacional I+D+I (DEP2010-20565), the Comisión Nacional de Ciencia y Tecnología (FONDAP-15130011), and the European Union 7th Framework Programme (VP2HF-FP7-2013-611823).

Funding

GG was awarded the Grant Bal Du Coeur from the Fondation de l’Institut de Cardiologie de Montréal.

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Authors and Affiliations

  1. Cardiology Department, Hospital Clínic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain

    Geneviève Giraldeau, Nicolas Duchateau, Luigi Gabrielli, Diego Penela, Reinder Evertz, Lluis Mont, Josep Brugada, Antonio Berruezo & Marta Sitges

  2. Institut d’investigacions Biomèdiques August Pi i Sunyer, c/ Rosselló 149-153, 08036, Barcelona, Spain

    Geneviève Giraldeau, Nicolas Duchateau, Luigi Gabrielli, Diego Penela, Reinder Evertz, Lluis Mont, Josep Brugada, Antonio Berruezo & Marta Sitges

  3. Universitat Pompeu Fabra, c/ Roc Boronat 138, 08018, Barcelona, Spain

    Nicolas Duchateau & Bart Bijnens

  4. Institució Catalana de Recerca i Estudis Avançats, Pg/ Lluís Companys 23, 08010, Barcelona, Spain

    Bart Bijnens

  5. División de Enfermedades Cardiovasculares, Advanced Center for Chronic Diseases, Pontificia Universidad Católica de Chile, Marcoleta 367, 22354 3000, Santiago, Chile

    Luigi Gabrielli

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  1. Geneviève Giraldeau
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  2. Nicolas Duchateau
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Correspondence to Marta Sitges.

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Giraldeau, G., Duchateau, N., Bijnens, B. et al. Dyssynchronization reduces dynamic obstruction without affecting systolic function in patients with hypertrophic obstructive cardiomyopathy: a pilot study. Int J Cardiovasc Imaging 32, 1179–1188 (2016). https://doi.org/10.1007/s10554-016-0903-3

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