© 2008 European Society of Cardiology
Long term exercise capacity in patients with hypertrophic cardiomyopathy treated with percutaneous transluminal septal myocardial ablation
a 1st Department of Coronary Artery Disease and Catheterization Laboratory, Institute of Cardiology Warsaw, Poland
b Echocardiographic Laboratory, Institute of Cardiology Warsaw, Poland
c Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology Warsaw, Poland
* Corresponding author. 1st Coronary Disease Department and Catheterization Laboratory, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland. Tel.: +48 22 3434267; fax: +48 22 6133819. E-mail address: lmalek{at}ikard.pl (L.A. Malek)
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Abstract |
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Background: In hypertrophic obstructive cardiomyopathy, percutaneous transluminal septal myocardial ablation (PTSMA) improves functional capacity in the short term. However, long term functional capacity is unknown.
Aim: To assess the long term exercise capacity of patients with hypertrophic obstructive cardiomyopathy undergoing PTSMA.
Methods: Twenty three patients (56.5% male, mean age 44.5±13.6 years) who underwent PTSMA were included. All patients had also undergone a symptom limited cardiopulmonary exercise treadmill test before the procedure, then after 3 months (early follow-up) and after a mean 7.2±1.0 years (long term follow-up).
Results: Before PTSMA, mean maximal pressure gradient in the left outflow tract (LVOTGmax) was 82±29 mmHg, 17 patients had NYHA functional class 
III and peak oxygen uptake (pVO2) was 18±4 ml/kg/min. PTSMA led to a reduction in mean LVOTGmax (to 29 ± 19 mmHg. p<.0001), improvement of heart failure symptoms (NYHAIII in 1 patient, p<.0001) and an increase of pVO2 (to 22±6 ml/kg/min, p =.0002) at short term. LVOTGmax, functional class and pVO2 did not change significantly during long term follow-up compared to early follow-up. However, there was a continuous improvement in percentage predicted pVO2 over time.
Conclusions: In patients with hypertrophic obstructive cardiomyopathy and symptoms of heart failure, PTSMA leads to stable long term improvement of objectively measured exercise capacity.
Key Words: Hypertrophic cardiomyopathy • Left ventricular outflow tract obstruction • Percutaneous transluminal septal myocardial ablation • Exercise capacity • Follow-up
Received May 9, 2008; Revised August 4, 2008; Accepted September 17, 2008