Markers of responsiveness to disopyramide in patients with hypertrophic cardiomyopathy.
Aged
Atrial Function
Cardiomyopathy, Hypertrophic
/ drug therapy
Cohort Studies
Disopyramide
/ therapeutic use
Echocardiography
Female
Humans
Male
Middle Aged
Stroke Volume
Treatment Outcome
Ventricular Function, Left
Ventricular Outflow Obstruction
/ complications
Voltage-Gated Sodium Channel Blockers
/ therapeutic use
Disopyramide
Echocardiography
Hypertrophic cardiomyopathy
LVOT obstruction
Strain
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
15 12 2019
15 12 2019
Historique:
received:
09
05
2019
revised:
11
09
2019
accepted:
23
09
2019
pubmed:
17
10
2019
medline:
11
7
2020
entrez:
17
10
2019
Statut:
ppublish
Résumé
Significant left-ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) may result in symptoms and is associated with adverse outcomes. Although disopyramide can reduce resting gradients, nearly 30% of HCM patients do not respond. We sought to study the clinical and echocardiographic variables associated with disopyramide-induced LVOT-gradient reduction. Forty-one disopyramide-treated HCM patients (average daily-dose 305 mg) were subdivided into two groups: (1) nineteen responders, with a reduction of LVOT-gradients of at least 30% from baseline, and (2) twenty-two non-responders, in whom LVOT-gradients did not change or increased following treatment. All patients had a thorough clinical and echocardiographic assessment pre- and post-treatment initiation. Patients who responded to disopyramide had better pretreatment left ventricular (LV) systolic function (LV ejection fraction of 67.9 ± 5.6% vs. 59.7 ± 5.8%, p = 0.0001), better LV global longitudinal strain (-17.9 ± 2.3% vs. -16.1 ± 2.5%, p = 0.048), less mitral regurgitation, smaller LV size (indexed LV end-systolic volume of 16.2 ± 5.1 ml/m Obstructive HCM patients with more severe disease at baseline tend to respond less to disopyramide treatment. In those patients, early referral for alcohol septal ablation or myectomy surgery should be considered.
Sections du résumé
BACKGROUND
Significant left-ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) may result in symptoms and is associated with adverse outcomes. Although disopyramide can reduce resting gradients, nearly 30% of HCM patients do not respond. We sought to study the clinical and echocardiographic variables associated with disopyramide-induced LVOT-gradient reduction.
METHODS
Forty-one disopyramide-treated HCM patients (average daily-dose 305 mg) were subdivided into two groups: (1) nineteen responders, with a reduction of LVOT-gradients of at least 30% from baseline, and (2) twenty-two non-responders, in whom LVOT-gradients did not change or increased following treatment. All patients had a thorough clinical and echocardiographic assessment pre- and post-treatment initiation.
RESULTS
Patients who responded to disopyramide had better pretreatment left ventricular (LV) systolic function (LV ejection fraction of 67.9 ± 5.6% vs. 59.7 ± 5.8%, p = 0.0001), better LV global longitudinal strain (-17.9 ± 2.3% vs. -16.1 ± 2.5%, p = 0.048), less mitral regurgitation, smaller LV size (indexed LV end-systolic volume of 16.2 ± 5.1 ml/m
CONCLUSIONS
Obstructive HCM patients with more severe disease at baseline tend to respond less to disopyramide treatment. In those patients, early referral for alcohol septal ablation or myectomy surgery should be considered.
Identifiants
pubmed: 31615649
pii: S0167-5273(19)32410-6
doi: 10.1016/j.ijcard.2019.09.066
pii:
doi:
Substances chimiques
Voltage-Gated Sodium Channel Blockers
0
Disopyramide
GFO928U8MQ
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
75-82Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.