P153. Segmental Left Ventricular Strain Changes and Mortality Risk After Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy
Northwestern University Feinberg School of Medicine
Chicago, IL
United States - Contact Me
Dr. Kislitsina then trained in Cardiology and received her PhD degree from the Bakoulev National Scientific Centre for Cardiovascular Surgery, Moscow University School of Medicine.
After completing her residency and fellowship training in Cardiology, Dr. Kislitsina was invited to join the faculty of the Bakoulev National Scientific Centre for Cardiovascular Surgery as a Clinical Cardiologist.
In 2016, Dr. Kislitsina served one year as the Senior Research Scientist for CorMatrix Cardiovascular, Inc. in Atlanta, Georgia, USA where she evaluated the use of extracellular matrix (ECM) and stem cells for the treatment of heart failure. In February 2018, Dr. Kislitsina was appointed as Research Associate Professor in Medicine (Cardiology) at the Feinberg School of Medicine and as the Associate Director of the Center for Heart Failure Research at the Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA.
Description
Methods: We retrospectively analyzed 187 HOCM patients who underwent speckle-tracking segmental strain analysis preoperatively and one year following septal myectomy. Logistic regression models adjusted for demographics, clinical risk factors, and systolic anterior motion of the mitral valve were used to assess segmental strain associations with postoperative mortality.
Results: The mean age was 56.9 ± 15.6 years. Baseline LV global longitudinal strain (LVGLS) was -18.6% (Q1-Q3: -20.3, -16.5), and LV ejection fraction was 66.3% (61.6, 72.7). At 1 year, GLS showed minimal overall change. Segment 3 (basal anteroseptal) improved slightly (+0.6 percentage points [pp], p=0.04) but was not independently associated with mortality. Preoperative segment 4 (basal inferoseptal) independently predicted higher postoperative mortality (OR 1.10 per 1-pp less negative strain, p=0.05)-approximately 10% higher risk per 1-pp worsening. Preoperative segment 12 (mid-anterolateral) was associated with improved survival (OR 0.90 per 1-pp more negative, p=0.05)-approximately 10% lower risk per 1-pp improvement. Postoperative segment 10 (mid-inferior) improvement was associated with lower mortality (OR 0.71 per 1-pp more negative, p=0.05)- approximately 29% lower risk per 1-pp improvement (Figure1).
Conclusions: Preoperative and post-myectomy segmental LV strain analysis identifies prognostically significant regions, particularly the basal inferior septal segment 4. Improved strain in this LV segment post-myectomy markedly reduces mortality risk. Targeted monitoring of segment-specific LV strain provides valuable prognostic insight and preoperative risk stratification and postoperative management strategies for HOCM patients undergoing septal myectomy.
Authors
Olga Kislitsina (1), Lubna Choudhury (1), Kifah Hussain (1), Bonnie Kane (1), James Thomas (1), Abigail Baldridge (1), Seokyung An (1), Jane Kruse (2), James Cox (1), Patrick McCarthy (1), Douglas Johnston (1)
Institutions
(1) Northwestern University, Chicago, IL, (2) Northwestern Medicine, Chicago, IL