Clinical and echocardiographic determinants of long-term survival after surgical myectomy in obstructive hypertrophic cardiomyopathy. Export

@article{citeulike:363081, abstract = {BACKGROUND: Surgical myectomy has been the standard treatment for patients with drug-refractory obstructive hypertrophic cardiomyopathy. The clinical and echocardiographic predictors of long-term survival and freedom from cardiovascular morbidity after myectomy have been unclear. METHODS AND RESULTS: We studied a consecutive cohort of 338 adult patients (age at operation 47+/-14 [range 18 to 77] years, 60\% male) who underwent myectomy at our institution. Preoperative resting left ventricular outflow tract (LVOT) gradient was 66+/-32 mm Hg (range 5 to 158 mm Hg). Early postoperative mortality was 1.5\% (5 deaths): 4 deaths occurred between 1978 and 1992, and 1 death occurred between 1993 and 2002. During long-term follow-up, 83\% of patients reported an improvement to functional class I or II. The majority of patients (98\%) had no resting LVOT gradient. Long-term survival was excellent, with 98+/-1\% survival at 1 year, 95+/-1\% at 5 years, and 83+/-3\% at 10 years after myectomy. Multivariable Cox regression analysis identified 5 predictors of overall mortality: (1) age > or =50 years at surgery (hazard ratio [HR] 2.8, 95\% CI 1.5 to 5.1, P=0.001), (2) female gender (HR 2.5, 95\% CI 1.5 to 4.3, P=0.0009), (3) history of preoperative atrial fibrillation (HR 2.2, 95\% CI 1.2 to 4.0, P=0.008), (4) concomitant CABG (HR 3.7, 95\% CI 1.7 to 8.2, P=0.001), and (5) preoperative left atrial diameter > or =46 mm (HR 2.9, 95\% CI 1.6 to 5.4, P=0.0008). Significant predictors of late major cardiovascular events found on multivariable analysis were (1) female gender (HR 3.3, 95\% CI 2.0 to 5.4, P<0.0001), (2) history of preoperative atrial fibrillation (HR 1.9, 95\% CI 1.1 to 3.3, P=0.02), and (3) preoperative left atrial diameter > or =46 mm (HR 2.5, 95\% CI 1.5 to 4.3, P=0.0008). CONCLUSIONS: Myectomy provides excellent relief for LVOT obstruction in patients with hypertrophic cardiomyopathy. Preoperative clinical and echocardiographic variables can predict long-term outcome after myectomy.}, address = {Division of Cardiology, Toronto General Hospital, 4N-506, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. anna.woo@uhn.on.ca}, author = {Woo, A. and Williams, W. G. and Choi, R. and Wigle, E. D. and Rozenblyum, E. and Fedwick, K. and Siu, S. and Ralph-Edwards, A. and Rakowski, H.}, citeulike-article-id = {363081}, citeulike-linkout-0 = {http://dx.doi.org/10.1161/01.CIR.0000162460.36735.71}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/15824202}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=15824202}, day = {26}, doi = {10.1161/01.CIR.0000162460.36735.71}, issn = {1524-4539}, journal = {Circulation}, keywords = {cardiomyopathy, echocardiography, hypertrophy}, month = {April}, number = {16}, pages = {2033--2041}, posted-at = {2005-10-23 16:04:39}, priority = {2}, title = {Clinical and echocardiographic determinants of long-term survival after surgical myectomy in obstructive hypertrophic cardiomyopathy.}, url = {http://dx.doi.org/10.1161/01.CIR.0000162460.36735.71}, volume = {111}, year = {2005} }

TY - JOUR ID - citeulike:363081 L3 - citeulike-article-id:363081 N2 - BACKGROUND: Surgical myectomy has been the standard treatment for patients with drug-refractory obstructive hypertrophic cardiomyopathy. The clinical and echocardiographic predictors of long-term survival and freedom from cardiovascular morbidity after myectomy have been unclear. METHODS AND RESULTS: We studied a consecutive cohort of 338 adult patients (age at operation 47+/-14 [range 18 to 77] years, 60% male) who underwent myectomy at our institution. Preoperative resting left ventricular outflow tract (LVOT) gradient was 66+/-32 mm Hg (range 5 to 158 mm Hg). Early postoperative mortality was 1.5% (5 deaths): 4 deaths occurred between 1978 and 1992, and 1 death occurred between 1993 and 2002. During long-term follow-up, 83% of patients reported an improvement to functional class I or II. The majority of patients (98%) had no resting LVOT gradient. Long-term survival was excellent, with 98+/-1% survival at 1 year, 95+/-1% at 5 years, and 83+/-3% at 10 years after myectomy. Multivariable Cox regression analysis identified 5 predictors of overall mortality: (1) age > or =50 years at surgery (hazard ratio [HR] 2.8, 95% CI 1.5 to 5.1, P=0.001), (2) female gender (HR 2.5, 95% CI 1.5 to 4.3, P=0.0009), (3) history of preoperative atrial fibrillation (HR 2.2, 95% CI 1.2 to 4.0, P=0.008), (4) concomitant CABG (HR 3.7, 95% CI 1.7 to 8.2, P=0.001), and (5) preoperative left atrial diameter > or =46 mm (HR 2.9, 95% CI 1.6 to 5.4, P=0.0008). Significant predictors of late major cardiovascular events found on multivariable analysis were (1) female gender (HR 3.3, 95% CI 2.0 to 5.4, P<0.0001), (2) history of preoperative atrial fibrillation (HR 1.9, 95% CI 1.1 to 3.3, P=0.02), and (3) preoperative left atrial diameter > or =46 mm (HR 2.5, 95% CI 1.5 to 4.3, P=0.0008). CONCLUSIONS: Myectomy provides excellent relief for LVOT obstruction in patients with hypertrophic cardiomyopathy. Preoperative clinical and echocardiographic variables can predict long-term outcome after myectomy. IS - 16 JF - Circulation SN - 1524-4539 AD - Division of Cardiology, Toronto General Hospital, 4N-506, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. anna.woo@uhn.on.ca EP - 2041 TI - Clinical and echocardiographic determinants of long-term survival after surgical myectomy in obstructive hypertrophic cardiomyopathy. VL - 111 SP - 2033 KW - cardiomyopathy KW - echocardiography KW - hypertrophy AU - Woo, A AU - Williams, WG AU - Choi, R AU - Wigle, ED AU - Rozenblyum, E AU - Fedwick, K AU - Siu, S AU - Ralph-Edwards, A AU - Rakowski, H PY - 2005/04/26/ UR - http://dx.doi.org/10.1161/01.CIR.0000162460.36735.71 ER -