Characteristics of myocardial postsystolic shortening in patients with symptomatic hypertrophic obstructive cardiomyopathy before and half a year after alcohol septal ablation assessed by speckle tracking echocardiography.

Jiansong Yuan,Fujian Duan,Shubin Qiao,Hao Wang,Jiafen Zhang,Shi Chen,Yiru Guo

doi:10.1371/journal.pone.0099014

Abstract

ObjectivesPostsystolic shortening (PSS) has been proposed as a marker of myocardial dysfunction. Percutaneous transluminal septal myocardial ablation (PTSMA) is an alternative therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) that results in sustained improvements in atrial structure and function. We investigated the effects of PTSMA on PSS in HOCM patients using speckle tracking imaging.MethodsConventional echocardiographic and PSS parameters were obtained in 18 healthy controls and 30 HOCM patients before and half a year after PTSMA.ResultsCompared with the healthy controls, the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. At 6 months after PTSMA, both the number of segments having PSS (10.5±2.8 vs. 13.2±2.6; P<0.001) and the average value of PSS (−1.24±0.57 vs. −1.55±0.56; P = 0.009) were significantly reduced. Moreover, the reductions in the average value of PSS correlated well with the reductions in the E-to-Ea ratio (r = 0.705, P<0.001).ConclusionsBoth the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. PTSMA has a favourable effect on PSS, which may partly account for the persistent improvement in LV diastolic function in HOCM patients after PTSMA.

Highlights

Postsystolic shortening (PSS) is considered myocardial shortening after the point of aortic valve closure, which has been known for years
There were no significant differences between the two groups in terms of age, gender, height, weight, heart rate, systolic blood pressure or diastolic blood pressure
The mean New York Heart Association (NYHA) functional class was 2.760.3, and 73.3% of the patients were in the NYHA functional class III despite optimal medical therapy that consisted of betablockers in 23 (76.7%) patients and calcium-channel blockers in 7 (26.7%) patients

Summary

Introduction

Postsystolic shortening (PSS) is considered myocardial shortening after the point of aortic valve closure, which has been known for years. A previous study observed that patients with hypertrophic cardiomyopathy (HCM) had more PSS than normal controls [4]. Percutaneous transluminal septal myocardial ablation (PTSMA) is an alternative type of therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) that may result in the long-term improvement of symptoms and partly reverse myocardial ischemia and fibrosis [8,9,10,11]. It is unclear whether PTSMA can decrease PSS in HOCM patients.

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