Determinants of Reverse Remodeling of the Left Atrium After Transaortic Myectomy

Anita Nguyen, Hartzell V Schaff, Rick A. Nishimura, Joseph A. Dearani, Jeffrey B. Geske, Brian D. Lahr, Steve R. Ommen

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: In patients with hypertrophic cardiomyopathy (HCM), enlargement of the left atrium (LA) is associated with increased morbidity and mortality because of risk of atrial fibrillation (AF), stroke, and heart failure. In this study, we investigated whether LA reverse remodeling occurs after septal myectomy. Methods: Between August 2007 and July 2015, 656 patients underwent myectomy at our institution and had preoperative and postoperative transthoracic echocardiographic (TTE) recording of LA volume index (LAVI). We reviewed clinical and echocardiographic data of these patients, and assessed for changes over time by comparing preoperative and postoperative measurements. Results: The median age was 56 (interquartile range [IQR], 46, 65) years, and 370 (56%) were male. New York Heart Association Class III/IV dyspnea was present in 581 (89%). Preoperative TTE showed LAVI of 48 (IQR, 38, 60) mL/m2. In patients with history of AF, preoperative LAVI was 57 (IQR, 45, 68) mL/m2, and in those without AF, LAVI measured 45 (IQR, 37, 57) mL/m2 (p < 0.001). All patients underwent transaortic septal myectomy. Early postoperative TTE (4 [IQR, 3, 5] days) demonstrated LAVI of 43 (IQR, 36, 52) mL/m2 (p < 0.001), and late postoperative TTE (2.0 [IQR, 1.1, 4.1] years) showed LAVI of 38 (29, 47) mL/m2 (p < 0.001). Preoperative LAVI was associated with late development of AF (p = 0.002). Conclusions: Left atrial volume decreases significantly after surgical relief of left ventricular outflow tract obstruction. Early changes likely reflect lower LA pressure due to gradient relief and abolishment of mitral regurgitation, and late reduction suggests continued reverse remodeling.

Original languageEnglish (US)
Pages (from-to)447-453
Number of pages7
JournalAnnals of Thoracic Surgery
Volume106
Issue number2
DOIs
StatePublished - Aug 1 2018

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Heart Atria
Atrial Fibrillation
Atrial Remodeling
Ventricular Outflow Obstruction
Hypertrophic Cardiomyopathy
Mitral Valve Insufficiency
Dyspnea
Heart Failure
Stroke
Morbidity
Pressure
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Nguyen, A., Schaff, H. V., Nishimura, R. A., Dearani, J. A., Geske, J. B., Lahr, B. D., & Ommen, S. R. (2018). Determinants of Reverse Remodeling of the Left Atrium After Transaortic Myectomy. Annals of Thoracic Surgery, 106(2), 447-453. https://doi.org/10.1016/j.athoracsur.2018.03.039

Determinants of Reverse Remodeling of the Left Atrium After Transaortic Myectomy. / Nguyen, Anita; Schaff, Hartzell V; Nishimura, Rick A.; Dearani, Joseph A.; Geske, Jeffrey B.; Lahr, Brian D.; Ommen, Steve R.

In: Annals of Thoracic Surgery, Vol. 106, No. 2, 01.08.2018, p. 447-453.

Research output: Contribution to journalArticle

Nguyen, A, Schaff, HV, Nishimura, RA, Dearani, JA, Geske, JB, Lahr, BD & Ommen, SR 2018, 'Determinants of Reverse Remodeling of the Left Atrium After Transaortic Myectomy', Annals of Thoracic Surgery, vol. 106, no. 2, pp. 447-453. https://doi.org/10.1016/j.athoracsur.2018.03.039
Nguyen, Anita ; Schaff, Hartzell V ; Nishimura, Rick A. ; Dearani, Joseph A. ; Geske, Jeffrey B. ; Lahr, Brian D. ; Ommen, Steve R. / Determinants of Reverse Remodeling of the Left Atrium After Transaortic Myectomy. In: Annals of Thoracic Surgery. 2018 ; Vol. 106, No. 2. pp. 447-453.
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T1 - Determinants of Reverse Remodeling of the Left Atrium After Transaortic Myectomy

AU - Nguyen, Anita

AU - Schaff, Hartzell V

AU - Nishimura, Rick A.

AU - Dearani, Joseph A.

AU - Geske, Jeffrey B.

AU - Lahr, Brian D.

AU - Ommen, Steve R.

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Y1 - 2018/8/1

N2 - Background: In patients with hypertrophic cardiomyopathy (HCM), enlargement of the left atrium (LA) is associated with increased morbidity and mortality because of risk of atrial fibrillation (AF), stroke, and heart failure. In this study, we investigated whether LA reverse remodeling occurs after septal myectomy. Methods: Between August 2007 and July 2015, 656 patients underwent myectomy at our institution and had preoperative and postoperative transthoracic echocardiographic (TTE) recording of LA volume index (LAVI). We reviewed clinical and echocardiographic data of these patients, and assessed for changes over time by comparing preoperative and postoperative measurements. Results: The median age was 56 (interquartile range [IQR], 46, 65) years, and 370 (56%) were male. New York Heart Association Class III/IV dyspnea was present in 581 (89%). Preoperative TTE showed LAVI of 48 (IQR, 38, 60) mL/m2. In patients with history of AF, preoperative LAVI was 57 (IQR, 45, 68) mL/m2, and in those without AF, LAVI measured 45 (IQR, 37, 57) mL/m2 (p < 0.001). All patients underwent transaortic septal myectomy. Early postoperative TTE (4 [IQR, 3, 5] days) demonstrated LAVI of 43 (IQR, 36, 52) mL/m2 (p < 0.001), and late postoperative TTE (2.0 [IQR, 1.1, 4.1] years) showed LAVI of 38 (29, 47) mL/m2 (p < 0.001). Preoperative LAVI was associated with late development of AF (p = 0.002). Conclusions: Left atrial volume decreases significantly after surgical relief of left ventricular outflow tract obstruction. Early changes likely reflect lower LA pressure due to gradient relief and abolishment of mitral regurgitation, and late reduction suggests continued reverse remodeling.

AB - Background: In patients with hypertrophic cardiomyopathy (HCM), enlargement of the left atrium (LA) is associated with increased morbidity and mortality because of risk of atrial fibrillation (AF), stroke, and heart failure. In this study, we investigated whether LA reverse remodeling occurs after septal myectomy. Methods: Between August 2007 and July 2015, 656 patients underwent myectomy at our institution and had preoperative and postoperative transthoracic echocardiographic (TTE) recording of LA volume index (LAVI). We reviewed clinical and echocardiographic data of these patients, and assessed for changes over time by comparing preoperative and postoperative measurements. Results: The median age was 56 (interquartile range [IQR], 46, 65) years, and 370 (56%) were male. New York Heart Association Class III/IV dyspnea was present in 581 (89%). Preoperative TTE showed LAVI of 48 (IQR, 38, 60) mL/m2. In patients with history of AF, preoperative LAVI was 57 (IQR, 45, 68) mL/m2, and in those without AF, LAVI measured 45 (IQR, 37, 57) mL/m2 (p < 0.001). All patients underwent transaortic septal myectomy. Early postoperative TTE (4 [IQR, 3, 5] days) demonstrated LAVI of 43 (IQR, 36, 52) mL/m2 (p < 0.001), and late postoperative TTE (2.0 [IQR, 1.1, 4.1] years) showed LAVI of 38 (29, 47) mL/m2 (p < 0.001). Preoperative LAVI was associated with late development of AF (p = 0.002). Conclusions: Left atrial volume decreases significantly after surgical relief of left ventricular outflow tract obstruction. Early changes likely reflect lower LA pressure due to gradient relief and abolishment of mitral regurgitation, and late reduction suggests continued reverse remodeling.

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