Reply to “Is the cause of death in hypertrophic cardiomyopathy low pressure gradient in left ventricular outflow?”

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Kestelli and associates1Kestelli M. Yurekli I. Bademci M. Is the cause of death in hypertrophic cardiomyopathy low pressure gradient in left ventricular outflow [letter]?.J Thorac Cardiovasc Surg. 2012; 144: 1537Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar 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.”2Schaff 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 As shown in Table 2 in our original article,2Schaff 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 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. We did not postulate that wall thickness had any impact on survival one way or the other. In our previous studies, however, left ventricular mass and wall thickness were not found to be predictors of late survival after myectomy for hypertrophic obstructive cardiomyopathy, a finding that is in contrast to the results of natural history studies of patients who were not treated surgically.3Brown M.L. Schaff H.V. Dearani J.A. Li Z. Nishimura R.A. Ommen S.R. Relationship between left ventricular mass, wall thickness, and survival after subaortic septal myectomy for hypertrophic obstructive cardiomyopathy.J Thorac Cardiovasc Surg. 2011; 141: 439-443Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The apparent minor difference in survival of patients with latent obstruction in our original Figures 2 and 4 is actually due to a slight difference in the number of patients for whom matching was possible in the age-matched and sex-matched population. The conclusion drawn by Kestelli and associates1Kestelli M. Yurekli I. Bademci M. Is the cause of death in hypertrophic cardiomyopathy low pressure gradient in left ventricular outflow [letter]?.J Thorac Cardiovasc Surg. 2012; 144: 1537Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar from the article by Ommen and colleagues4Ommen 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 is incorrect. In that series, which also came from our clinic, the late survival of patients with obstructive hypertrophic cardiomyopathy who underwent myectomy was similar to the survival of patients who had hypertrophic cardiomyopathy without obstruction. Left ventricular outflow tract obstruction left untreated in patients with hypertrophic cardiomyopathy is associated with reduced late survival,5Maron M.S. Olivotto I. Betocchi S. Casey S.A. Lesser J.R. Losi M.A. et al.Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy.N Engl J Med. 2003; 348: 295-303Crossref PubMed Scopus (1080) Google Scholar and this situation seems to be improved after myectomy. Is the cause of death in hypertrophic cardiomyopathy low pressure gradient in left ventricular outflow?The Journal of Thoracic and Cardiovascular SurgeryVol. 144Issue 6PreviewWe congratulate Schaff and colleagues1 on their recent study. We wish, however, to emphasize some points that we believe they should have taken into consideration. Full-Text PDF