Is the cause of death in hypertrophic cardiomyopathy low pressure gradient in left ventricular outflow?

Abstract

We congratulate Schaff and colleagues1Schaff H.V. Dearani J.A. Ommen S.R. Sorajja P. Nishimura R.A. Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: results of operation in patients with latent obstruction.J Thorac Cardiovasc Surg. 2012; 143: 303-309Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar on their recent study. We wish, however, to emphasize some points that we believe they should have taken into consideration. We could not figure out how to correlate the preoperatively used drug with the survival rate (see original Table 21Schaff H.V. Dearani J.A. Ommen S.R. Sorajja P. Nishimura R.A. Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: results of operation in patients with latent obstruction.J Thorac Cardiovasc Surg. 2012; 143: 303-309Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar). To agree with the results, one should standardize the last echocardiographic data of the lost patients with those of the living patients. We think that preoperative echocardiographic status of the patient could not be correlated with the survival of the 6th postoperative year. We could not clearly understand whether it was postulated that the wall thickness of 22 mm (see original Figure 41Schaff H.V. Dearani J.A. Ommen S.R. Sorajja P. Nishimura R.A. Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: results of operation in patients with latent obstruction.J Thorac Cardiovasc Surg. 2012; 143: 303-309Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar) did not have an impact on survival or whether one would bring the survival to an expected level with the use of drugs? We think that the original Figure 2 is in contradiction with the original Figure 4.1Schaff H.V. Dearani J.A. Ommen S.R. Sorajja P. Nishimura R.A. Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: results of operation in patients with latent obstruction.J Thorac Cardiovasc Surg. 2012; 143: 303-309Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar Ommen and associates2Ommen S.R. Maron B.J. Olivotto I. Maron M.S. Cecchi F. Betocchi S. et al.Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy.J Am Coll Cardiol. 2005; 46: 470-476Abstract Full Text Full Text PDF PubMed Scopus (603) Google Scholar previously stated that the pressure gradient does not have an impact on (cardiac) survival because their mortality was also 6% in the nonobstructive group. Nevertheless, there was limited information because of the lack of postoperative echocardiographic data in the myectomy group with respect to postoperative pressure gradient, wall thickness, and left ventricular diameters. The standardization of the groups after inclusion of the final echocardiographic data of the lost patients would yield the definitive results of this study. Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: Results of operation in patients with latent obstructionThe Journal of Thoracic and Cardiovascular SurgeryVol. 143Issue 2PreviewMany patients with symptomatic hypertrophic cardiomyopathy have minimal left ventricular outflow tract gradients, and there is uncertainty whether their limitation is due to diastolic dysfunction or labile outflow tract obstruction. The purpose of this study was to characterize the clinical presentation and outcome of septal myectomy in patients with hypertrophic cardiomyopathy and latent obstruction. Full-Text PDF Reply to “Is the cause of death in hypertrophic cardiomyopathy low pressure gradient in left ventricular outflow?”The Journal of Thoracic and Cardiovascular SurgeryVol. 147Issue 6PreviewKestelli and associates1 may have misunderstood the analysis in my group's article, “Expanding the Indications for Septal Myectomy in Patients With Hypertrophic Cardiomyopathy: Results of Operation in Patients With Latent Obstruction.”2 As shown in Table 2 in our original article,2 preoperative medication use was generally similar between the patients with latent obstruction (gradients of 30 mm Hg or less) and those with high resting gradients (greater than 30 mm Hg). We did not analyze survival according to preoperative drug use, and if, in fact, medications had any substantial impact on late survival, such an effect would likely be related to postoperative medication use rather than to preoperative medication use. Full-Text PDF