Septal Myectomy Improves QoL in Patients With Obstructive Hypertrophic Cardiomyopathy

In patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM), septal myectomy significantly increased functional capacity and overall quality of life (QoL), according to findings published in JAMA Network Open.

Patients with symptomatic obstructive HCM prospectively enrolled in the study were scheduled to undergo septal myectomy within 90 days of evaluation between March 2017 and June 2020 at Cleveland Clinic.

The Kansas City Cardiomyopathy Questionnaire (KCCQ), which focused on summary, symptoms, physical limitation, social limitations and QoL was conducted at baseline and follow up to record patient scores ranging from 0 to 100 with better outcomes signified by higher scores.

Scores ranging from 0 to 24 were determined poor, 25 to 49 were fair, 50 to 74 were good, and 75 to 100 were excellent.

Of the 173 patients with obstructive HCM included in the study, the mean age was 52 years, 107 (62%) were men, 121 (70%) underwent isolated septal myectomy, and 52 patients (30%) underwent septal myectomy with mitral valve or papillary muscle surgery.

Results showed no perioperative strokes, 1 death occurred 3 weeks after procedure, and a pacemaker was needed in 5 patients (3%).

Of the 136 patients (79%) who completed follow up 14 months post septal myectomy, 125 patients (92%) achieved the primary endpoint, 109 (80%) experienced a large increase of more than 20 points, 6 (4%) had a reduction, and 5 (4%) had no change in KCCQ summary score.

In baseline New York Heart Association (NYHA) Class II, researchers observed an increase of at least 5 points in KCCQ summary score in 54 of 62 patients (87%) and in NYHA Class III or IV (P = .40) the same increase was observed in 71 of 74 patients (96%).

“In this cohort study, patients with symptomatic obstructive HCM reported a significant increase in patient-reported QoL after septal myectomy, including 80% of patients demonstrating an increase of more than 20 points in KCCQ summary score,” wrote study authors.

According to researchers, this increase in KCCQ summary score was substantially larger than what has previously been published for obstructive HCM as well as other diseases.

“Furthermore, 8% of patients did not have improved KCCQ score, likely owing to an underrecognized phenotype with advanced disease (eg, diastolic dysfunction), obesity, and deconditioning associated with long-term restriction in physical activity,” reported researchers.

Study authors concluded that it remains to be determined whether this significant increase in overall QoL and functional capacity is maintained over the long term.

Reference:
Desai MY, Tower-Rader A, Szpakowski N, Mentias A, Popovic ZB, Smedira NG. Association of septal myectomy with quality of life in patients with left ventricular outflow tract obstruction from hypertrophic cardiomyopathy. JAMA Netw Open. 2022;5(4):e227293. doi:10.1001/jamanetworkopen.2022.7293