Late enhancement and myocardial perfusion in hypertrophic cardiomyopathy (comparison between groups).

BACKGROUND: The magnetic resonance imaging (MRI) is an effective method to study hypertrophic cardiomyopathy (HCM). OBJECTIVE: To evaluate, using MRI, the parameters of systolic function, perfusion and myocardial viability in patients with HCM, comparing the groups with and without obstruction of the left ventricular outflow tract. METHODS: Twenty-one patients with a diagnosis of HCM underwent the assessment of myocardial function, viability and perfusion under stress and at rest through MRI. RESULTS: The ventricular segments most severely impaired by hypertrophy were those of the septal region. The obstructive group presented segmental myocardial thickening distribution similar to the non-obstructive group, but with higher means than the first group. The mean ejection fraction of the patients in the obstructive group was higher than in the non-obstructive group, whereas the means of the end systolic and diastolic volumes were lower in the obstructive group. There was a positive correlation between the ventricular segmental thickening and the late enhancement segmental mass. The stress induction resulted in an increase in the number of segments with perfusion alterations and this alteration was more evident in the obstructive group. CONCLUSION: The thickest ventricular segments are the septal ones. The hypertrophic regions are associated to a greater extension of late enhancement. There was a positive correlation between the areas of ventricular hypertrophy and altered myocardial perfusion and these findings were more evident in the obstructive group.

Realce tardio e perfusão miocárdica em cardiomiopatia hipertrófica (comparação entre grupos) / Late enhancement and myocardial perfusion in hypertrophic cardiomyopathy (comparison betw een groups)

FUNDAMENTO: A ressonância magnética é um método eficaz para estudo da cardiomiopatia hipertrófica. OBJETIVO: Avaliar, pela ressonância magnética, os parâmetros de função sistólica, perfusão e viabilidade miocárdica em pacientes portadores de cardiomiopatia hipertrófica, comparando os grupos com e sem obstrução na via de saída do ventrículo esquerdo. MÉTODO: Vinte e um pacientes com diagnóstico de cardiomiopatia hipertrófica realizaram estudos de função, viabilidade e perfusão miocárdica nas fases de estresse e de repouso pela ressonância magnética. RESULTADOS: Os segmentos ventriculares mais comprometidos pela hipertrofia foram os da região septal. O grupo obstrutivo apresentou distribuição segmentar de espessura miocárdica semelhante ao não-obstrutivo, porém com maiores médias que o primeiro grupo. A média da fração de ejeção dos pacientes do grupo obstrutivo foi maior que o grupo não-obstrutivo, enquanto as médias dos volumes sistólico e diastólico finais foram menores no grupo obstrutivo. Houve correlação positiva entre a espessura segmentar do ventrículo e a massa segmentar do realce tardio. A indução de estresse determinou aumento do número de segmentos com alteração de perfusão e essa alteração foi mais evidente no grupo obstrutivo. CONCLUSÃO: Os segmentos ventriculares com maior espessura são os septais. As regiões hipertróficas estão associadas à maior extensão de realce tardio. Houve correlação positiva entre as áreas de hipertrofia ventricular e perfusão miocárdica alterada, e esses achados foram mais evidentes no grupo obstrutivo.

BACKGROUND: The magnetic resonance imaging (MRI) is an effective method to study hypertrophic cardiomyopathy (HCM). OBJECTIVE: To evaluate, using MRI, the parameters of systolic function, perfusion and myocardial viability in patients with HCM, comparing the groups with and without obstruction of the left ventricular outflow tract. METHODS: Twenty-one patients with a diagnosis of HCM underwent the assessment of myocardial function, viability and perfusion under stress and at rest through MRI. RESULTS: The ventricular segments most severely impaired by hypertrophy were those of the septal region. The obstructive group presented segmental myocardial thickening distribution similar to the non-obstructive group, but with higher means than the first group. The mean ejection fraction of the patients in the obstructive group was higher than in the non-obstructive group, whereas the means of the end systolic and diastolic volumes were lower in the obstructive group. There was a positive correlation between the ventricular segmental thickening and the late enhancement segmental mass. The stress induction resulted in an increase in the number of segments with perfusion alterations and this alteration was more evident in the obstructive group. CONCLUSION: The thickest ventricular segments are the septal ones. The hypertrophic regions are associated to a greater extension of late enhancement. There was a positive correlation between the areas of ventricular hypertrophy and altered myocardial perfusion and these findings were more evident in the obstructive group.

Cardiac pacing in hypertrophic cardiomyopathy: a cohort with 24 years of follow-up.

BACKGROUND: The benefits of heart stimulation in hypertrophic cardiomyopathy (HCM) patients have been questioned. Research work available in Brazil on those benefits is scarce. OBJECTIVE: To describe the indication, clinical response, complications and survival time related to pacemaker implant in HCM patients. METHODS: Thirty-nine hypertrophic cardiomyopathy patients were studied (41% males) and submitted to pacemaker implant from May, 1980 through November, 2003. RESULTS: Twenty-seven patients presented obstructive hypertrophic cardiomyopathy, and 12, non-obstructive. Mean age was 46.4 years of age (range 14-77), with follow-up of 6.4+/-4.1 years. Major indications for implant were: spontaneous or induced atrioventricular block (54%), refractoriness to therapeutic conduct associated to high gradient (33%), support for drug therapy to treat bradychardia (8%), and atrial fibrillation prevention (5%). Functional class was shown to improve from 2.41+/-0.87 to 1.97+/-0.92 (p=0.008), and symptoms referred were reduced. No change was made in drug therapy administration. No procedure-related deaths were reported. Although shown to be safe, the procedure was not free from complications (6 patients--15.4%). Three deaths occurred in the follow-up period--the three of them were atrial fibrillation female patients, with evidence of functional deterioration. A close association was observed between clinical condition worsening and the onset of atrial fibrillation or flutter. CONCLUSION: Cardiac pacing in HCM patients was successful, with evidence of symptoms relief in obstructive HCM patients. No functional improvement was observed in non-obstructive patients.

Estimulação cardíaca artificial em pacientes portadores de cardiomiopatia hipertrófica: uma coorte com 24 anos de seguimento / Cardiac pacing in hypertrophic cardiomyopathy: a cohort with 24 years of follow-up

FUNDAMENTO: O benefício da estimulação cardíaca em pacientes portadores de cardiomiopatia hipertrófica (CMH) tem sido questionado, sendo escassas as pesquisas sobre este assunto no Brasil. OBJETIVO: Descrever a indicação, a resposta clínica, as complicações e a sobrevida relacionadas ao implante de marcapasso em pacientes portadores de CMH. MÉTODOS: Foram estudados, retrospectivamente, 39 pacientes portadores de cardiomiopatia hipertrófica (41 por cento do sexo masculino) submetidos a implante de marcapasso, no período de maio de 1980 a novembro de 2003. RESULTADOS: Houve 27 portadores da forma obstrutiva e 12 portadores da forma não-obstrutiva com média de idade de 46,4 anos (14-77 anos) seguidos por 6,4 ± 4,1 anos. As principais indicações para implante foram: bloqueio atrioventricular espontâneo ou induzido (54 por cento), refratariedade à terapêutica associada a gradiente elevado (33 por cento), suporte para terapia medicamentosa por bradicardia (8 por cento) e prevenção de fibrilação atrial (5 por cento). Houve melhora na classe funcional de 2,41±0,87 para 1,97±0,92 (p = 0,008), bem como redução do número de sintomas referidos, sem ter havido diferença na utilização da terapia medicamentosa. Não houve óbitos relacionados ao procedimento que, apesar de demonstrar-se seguro, não foi isento de complicações (6 pacientes - 15,4 por cento). Ocorreram três óbitos durante o seguimento, todos em pacientes mulheres, portadoras de fibrilação atrial e com evidências de deterioração funcional. Observou-se uma forte associação de piora clínica com surgimento de fibrilação atrial ou flutter. CONCLUSÃO: A estimulação cardíaca artificial em pacientes com CMH foi bem-sucedida, com evidências de alívio sintomático em pacientes portadores da forma obstrutiva. Não se observou melhora funcional para a forma não-obstrutiva.

BACKGROUND: The benefits of heart stimulation in hypertrophic cardiomyopathy (HCM) patients have been questioned. Research work available in Brazil on those benefits is scarce. OBJECTIVE: To describe the indication, clinical response, complications and survival time related to pacemaker implant in HCM patients. METHODS: Thirty-nine hypertrophic cardiomyopathy patients were studied (41 percent males) and submitted to pacemaker implant from May, 1980 through November, 2003. RESULTS: Twenty-seven patients presented obstructive hypertrophic cardiomyopathy, and 12, non-obstructive. Mean age was 46.4 years of age (range 14 - 77), with follow-up of 6.4 ± 4.1 years. Major indications for implant were: spontaneous or induced atrioventricular block (54 percent), refractoriness to therapeutic conduct associated to high gradient (33 percent), support for drug therapy to treat bradychardia (8 percent), and atrial fibrillation prevention (5 percent). Functional class was shown to improve from 2.41±0.87 to 1.97±0.92 (p = 0.008), and symptoms referred were reduced. No change was made in drug therapy administration. No procedure-related deaths were reported. Although shown to be safe, the procedure was not free from complications (6 patients - 15.4 percent). Three deaths occurred in the follow-up period - the three of them were atrial fibrillation female patients, with evidence of functional deterioration. A close association was observed between clinical condition worsening and the onset of atrial fibrillation or flutter. CONCLUSION: Cardiac pacing in HCM patients was successful, with evidence of symptoms relief in obstructive HCM patients. No functional improvement was observed in non-obstructive patients.