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Objective Septal reduction therapies were recommended for drug-refractory patients with hypertrophic ob-structive cardiomyopathy(HOCM).To explore and compare the effectiveness and safety in patients with hypertrophic obstruc-tive cardiomyopathy(HOCM) treated with surgery myectomy(SM) and alcohol septal ablation(SA).Methods The clinical data of 260 patients performed SA(n=184) or SM(n=76)between September 2002 and September 2014 in our institute were retrospectively reviewed.The t-test, rank sum test and chi-square test were used to compare the differences between the two groups, and the Cox regression model was used for multivariate survival analysis.All-cause mortality, cardiac cause death(peri-operative death were included ) , heart function improvement , procedure-related complications and permanent pacemaker de-pendence( PPM) constituted the main contents of this study .Results Compared with patients treated with SM , patients un-dergone SA were poor heart function status(2.97 ±0.29 vs 2.50 ±0.56, P =0.01), more prevalence of atrial fibrillation( 15.14％ vs 6.80％, P=0.046) and longer follow-up period[(5.4 ±3.8) years vs(2.5 ±2.2) years, P =0.01)].All-cause mortality for SA and SM were 3.3％ and 14.5％ respectively(P=0.001).The fatal cardiac events of SA and SM were 1.63％ and 13.16％ respectively(P<0.001).Sudden cardiac arrest were the main cardiac cause death for both patients trea-ted with SA and SM.The cardiac death of left ventricular systolic dysfunction was main found in patients treated with SM . Heart function improvement(NYHA) after SA and SM were 1.23 ±0.61 and 0.88 ±0.64 respectively(all P <0.01).And SA had a lower procedure-related PPM implantation(1.63％ vs 4.20％, P<0.05).Conclusion Our results shown that SA have survival advantage, lower PPM and similar heart function improvement compared with SM for refractory patients with HOCM.
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Objective To investigate the effect of simvastatin on heme oxygenase (HO) -1expression and ventricular remodeling in rats with non-ischemic heart failure. Methods Seventy eight male Wistar rats were randomized into three groups: normal control group (n = 18), model group and simvastatin group (n= 60). Male Wistar rats in model and simvastatin group were given adrimycin(ADR) in an accumulated dose of 15 mg/kg for two weeks (2.5 mg /kg, peritoneal injection, three times per week), and 8 rats were dead. The survival rats (n= 52) were then randomly divided into two groups: model group (n=26) and simvastatin group (n=26), and 6 rats were dead in model group, while 7 dead in simvastatin group at the end of the study. Then rats in simvastatin treatment group(n=19)were given simvastatin 20 mg·kg-1·d-1 by gavage for four weeks,and rats in model group (n=20) and in control group (n=18) were treated with 5% glucose by gavage.At the forth week, another 9 rats were selected into the study and given ADR with an accumulated dose of 15 mg/kg for two weeks. The hemodynamics, mRNA expression of HO-1 in myocardium, left ventricular function as well as hydroxyproline were measured at the end of the sixth week. Results At the sixth week, compared with control group, systolic (+) and diastolic (-) function of the left ventricule (±LVdp/dtmax) of rats in model group and simvastatin group were reduced significantly, and the reduction amplitudes of + LVdp/dtmax and -LVdp/dtmax were 28.2%, 11.9% and 33.0%,27.9%,4, respectively (F = 4.899,3. 890, all P<0.01). The + LVdp/dtmax of rats in simvastatin group was higher than that in model group (F= 2.461, P<0.05). The content of myocardium hydroxyproline was elevated from the end of the second week [(485.0±52.9)g/kg vs. (364.0±41.6)g/kg,F=0.441 ,P<0.01]. At the end of the sixth week, the content of myocardium hydroxyproline of model group elevated continuously [(572.9±75.4) g/kg vs. (485.0±52.9)g/kg, F=0.654,P<0.05], but not for simvastatin group [(475.9±86.5) g/kg vs. (485.0±52.9)g/kg, P>0.05]. The mRNA expression of HO-1 in myocardium 'in model group was higher than that in control group [(0.6217±0.1229) vs. (0.2475±0.1053), F = 0.128, P < 0.01]. The mRNA expression of myocardium HO-1 was increased further by simvastatin treatment [(0.7860±0.1133) vs. (0.6217±0.1229),F=3.622,P<0.05]. Conclusions Compared with control group, the myocardial HO-1expression of heart failure rats is increased. Simvastatin treatment enhances the myocardium HO-1 expression further and alleviates myocardial injury and the degree of heart failure.
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Objective Fabry' s disease is a rare X-linked recessive disease. Its cardiac manifestations are not well recognized. Methods The data of 3 patients from different Chinese kindreds with Fabry's disease and cardiac manifestations who seeked medical advice in our department in 2007 were analyzed. The age, sex, family history, main symptoms, ECG and echocardiographic findings were recorded for all the patients. The diagnostic criteria of Fabry's disease was based on α-galactosidase (α-GAL) quantity in white blood cells. Results All of the patients were female. Their age was from 41 to 57. Two of them had the typical symptoms of Fabry's disease in their young age. All of them had family history of the disease and cardiac symptoms. ECG showed ST-T change and echocardiography showed hypertrophy of left ventricule of different degrees. Their α-galactosidase level in white blood cells was lower than normal. The α-galactosidase level in patient 1 was the lowest. Her cardiac symptoms were most serious in the three patients and she had involvement of other organs. Conclusion Patients with Fabry's disease may have cardiac manifestations. Family history, typical symptoms in young age and the characteristics of multi-systemic disorder are helpful clues to the diagnosis.
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Objective To explore the clinical features of hypertrophic cardiomyopathy (HCM) in aged patients in China. Methods The 711 patients with HCM in our hospital from Sep 2002 to Sep 2008 were retrospectively reviewed. Clinical data were compared between patients older and younger than 65 years. Results The 103 patients(14.5%) were older than 65 years. Compared with those patients younger than 65 years, the aged patients had a higher prevalence in female (52. 5 vs 29. 0%, P<0. 01), in comorbidity (64. 1% vs 25.0%, P<0, 01)and in atrial fibrillation (21.4% vs 14.0%, P<0. 05). Cardiac insufficiency was the most common symptom in aged patients with HCM. The age(r=0. 213, P<0. 05), size of left atrium (r=0. 308, P<0. 01) and atrial fibrillation (r= 0. 362, P<0. 01) had significant correlation with heart function. The 24 % of patients had one or more major risks for HCM-related sudden cardiac death (SCD), among which syncope was most common. Conclusions A higher prevalence of comorbidity, a higher incidence of atrial fibrillation and worse heart function existed in aged patients with HCM. The major risks for HCM-related SCD should not be neglected in evaluation for aged patients.
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Objective To observe the incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy (HCM).Methods 612 HCM patients were analyzed prospectively from July 1990 to November 2007.The age,sex,height,weight,medical history,main symptoms and incidence of atrial fibrillation were recorded.Results The patients'mean age was (47.8±14.9).414 patients(67.6%) were male.377 patients (61.6%)had left ventrieular outflow truer obstruction.94 patients(15.4%)and atrial fibrillation.43 patients(6.O%)had sustained and 51 patients (9.4%) had paroxysmal.The patients with atrial fibrillation were older in age and were predominantly female.Their medical history were longer,left atrial diameter(LAD)longer and plasma B-type natriuretie peptide(BNP)higher.logistic regression analysis indicated that the medical history(P=0.012),LAD(P=0.0001) and BNP (P=0.017)were the independent predictors of atrial fibrillation in HCM.Atrial fibrillation was accompanied by a decrease in functional status and an increase in risk of stroke.Conclusions The incidence of atrial fibrillation in HCM was high.The medical history.LAD and BNP were the independent predictors of its occurrence.
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Objective To show left anterior descending artery and interventricular septal branch Doppler flow and Doppler flow spectrum using coronary Doppler flow imaging,provide reference to select target artery,and judge collateral circulation formation after percutaneous transluminal septal myocardial ablation (PTSMA) of hypertrophic cardiomyopathy. Methods In 28 patients with hypertrophic cardiomyopathy left anterior descending artery and interventricular septum branch flow were displayed using coronary flow Doppler imaging system before and after PTSMA,and flow velocity were measured by Doppler spectrum. Results In 22 patients the target arteries were successfully selected in the first time using coronary flow Doppler imaging combined with coronary angiography and proved by the results of PTSMA. In 2 patients PTSMAs were performed successfully after additional choosing other interventricular septal branch. Therefore,PTSMAs in 24 patients were performed effectively in total. In 4 patients PTSMAs were given up due to vessel thinness and suffusion of interventricular septal branch in 2 patients,myocardial contrast agent distributing right ventricular and right ventricular papillary muscle during operation in one patient and contrast agent distributing left ventricular papillary muscle in another patient. Left ventricular flow tract pressure rebounded in 5 patients postoperatively,and neighboring interventricular septum branch extending to melting area were seen in 3 patients accompanied by flow velocity increasing. Melted vessel nub markedly prolonged in 1 patient. Conclusions Coronary Doppler flow imaging can directly reveal interventricular septum branch flow in hypertrophic cardiomyopathy,provide detailed hemodynamic information for myocardial PTSMA and monitor PTSMA for hypertrophic cardiomyopathy effectively and reliably.
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<p><b>OBJECTIVE</b>To evaluate the immediate and follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>METHODS</b>Fifteen symptomatic, drug-refractory patients with HOCM underwent PTSMA procedures with application of a myocardial contrast echocardiography (MCE) intra-procedure. Before and after the procedure, clinical evaluations were obtained in all patients, who were followed up for a mean period of 8.6 +/- 3.8 (6-20) months.</p><p><b>RESULTS</b>Immediate left ventricular outflow tract gradient (LVOTG) reduction was achieved (77.93 +/- 22 mm Hg vs 14.8 +/- 15 mm Hg, P < 0.0001) after the procedure with a mean decrease of 5.75 +/- 2.87 mm Hg of left ventricular end diastolic pressure (P < 0.001). Follow up results revealed that ventricular remodelling occurred mainly 1-3 months after the procedure, but without evidence of ventricular dilation and contract dysfunction. Heart function (NYHA) was greatly improved (3.4 +/- 0.5 vs 1.1 +/- 0.4, P < 0.001) and exercise endurance increased. A renewed increase of LVOTG was found in 2 patients during follow-up.</p><p><b>CONCLUSIONS</b>LVOTG was greatly decreased in HOCM patients undergoing a PTSMA procedure, and their symptoms were greatly improved without cardiac complications during follow-up. Sub-selection and reopening of target vessels were the causes of renewed increase of LVOTG, and this can be avoided with the accumulation of experience. This is a promising method for the treatment of symptomatic patients with HOCM.</p>