隐匿性肥厚梗阻性心肌病的外科治疗

目的明确隐匿性肥厚梗阻性心肌病的手术适应症,评价改良扩大室间隔肥厚心肌切除术(改良Morrow手术)治疗隐匿性肥厚梗阻性心肌病的手术效果。方法回顾性分析2009年10月至2011年8月阜外医院心外科手术治疗的74例肥厚梗阻性心肌病病人资料,其中5例符合隐匿性肥厚梗阻性心肌病标准,其中男4例,女1例,平均年龄33(22～43)岁,静息和运动激发试验后左室流出道压差(LVOTGP)平均为29.4(13～49)mmHg和105.2(91-124)mmHg,二尖瓣为少量(4例)或少中量(1例)返流。手术为全麻低温体外循环下经主动脉切口行改良扩大Morrow手术。分析比较患者手术前后超声心动图,通过门诊、电话随诊。结果本组围手术期存活率100%,手术效果好,无严重并发症,1例同期行二尖瓣置换术。主动脉阻断时间平均70.4分钟(35-157分钟),平均体外循环时间102.6分钟(49-225分钟)。患者术后LVOT压差平均为3.75mmHg(0--8mmHg),与术前相比有显著差异(p0.01)。术后二尖瓣为无返流4例,少量返流1例。平均随访11(4-20)个月,全部患者症状消失或减轻,心功能I～II级,无死亡或再次手术。结论运动激发试验用于隐匿性肥厚梗阻性心肌病患者的筛选有利于避免漏诊,改良Morrow手术治疗符合手术指征的隐匿性肥厚梗阻性心肌病具有良好的手术效果,早中期疗效满意。     

Early remodelling of left ventricle and improvement of myocardial performance in patients after percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy

BACKGROUND: Percutaneous transluminal septal myocardial ablation (PTSMA) reduces left ventricular outflow (LVOT) gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM) and leads to symptomatic improvement. Effects of PTSMA on left ventricular performance are currently unknown. The purpose of this study was to evaluate changes in the left ventricular performance using Doppler index of myocardial performance (sum of isovolumic contractile and relaxation times divided by left ventricular ejection time) and left ventricular remodelling after PTSMA for HOCM. METHODS: Twenty-five patients with symptomatic HOCM underwent echocardiography-guided PTSMA procedure. Clinical and echocardiographic data were collected at baseline and 3 months after PTSMA. RESULTS: PTSMA procedures were uneventful, in one patient (4%), pacemaker implantation was needed for sustained complete heart block after the procedure. At 3-month follow-up, the maximal LVOT gradient decreased from 68+/-39 to 18.6+/-12 mmHg (P<0.001), the provoked maximal LVOT gradient decreased from 128.8+/-59 to 25+/-21.4 mmHg (P<0.001), and basal septal thickness decreased from 21.7+/-4 to 15.2+/-3 mm (P<0.001). The improvement of the index of myocardial performance (from 0.65+/-7 to 0.56+/-11; P<0.001) was associated with neither significant change in left ventricular ejection fraction nor left ventricular ejection time. There was no significant difference in the left ventricular dimension at baseline and at follow-up. All patients reported a significant improvement in symptoms at follow-up, the mean NYHA class decreased from 2.6+/-0.7 to 1.4+/-0.7 (P<0.001), and the number of patients suffering from episodes of syncope or attacks of dizziness decreased from 13 to two during the 3-month follow-up. CONCLUSIONS: PTSMA is a safe, effective and reproducible method in the treatment of highly symptomatic patients with HOCM. This procedure results in a significant relief of symptoms associated with decrease in LVOT gradient and thickness of basal interventricular septum. Positive changes in Doppler IMP suggest possible improvement of left ventricular function.     

Improved hypertrophic obstructive cardiomyopathy by left ventricular apex epicardial pacing

We report a case of severe hypertrophic obstructive cardiomyopahy (HOCM) that was markedly improved by left ventricular (LV) apex epicardial pacing. A 55-year-old woman with HOCM had suffered from dyspnea. Cardiac catheter examination showed a resting pressure gradient across the LV outflow tract of 198 mmHg despite combined medication. During the examination, right dual-chamber pacing could not sufficiently reduce the pressure gradient. Therefore, we treated the patient with LV apex epicardial pacing. The procedure decreased the pressure gradient to 10 mmHg. Clinical symptoms were markedly improved. LV apex epicardial pacing may be an alternative therapy for patients with HOCM who are refractory to other medical treatment.     

Mid-Term Results of Dual-Chamber Pacing in Children with Hypertrophic Obstructive Cardiomyopathy

Background: Permanent dual-chambered pacing (DDD) is an alternative to surgical treatment in patients with severe hypertrophic obstructive cardiomyopathy (HOCM) who do not have a satisfactory response to medical treatment. Methods: Five children with severe HOCM still symptomatic despite medical treatment underwent permanent DDD pacing and were followed for 21 ± 9.7 months. Results: All patients improved their functional class. Doppler echocardiographic studies showed an early reduction of the left ventricular outflow tract gradient from 66 ± 40 to 40 ± 20 mmHg (P < 0.05) and to 30 ± 11 mmHg (P < 0.05 and NS for comparison with the baseline and the early post-DDD pacing gradients, respectively) at mid-term follow-up. There was no evidence of left ventricular systolic dysfunction, and the results of left ventricular filling studies ruled out deleterious effects on diastolic function. Doppler echocardiography played a key role in the initial and subsequent assessment of these patients. Conclusions: Permanent DDD pacing is a reasonable alternative to surgery in children with HOCM who are still symptomatic despite medical therapy.     

Long-term effects of dual-chamber pacing with periodic echocardiographic evaluation of optimal atrioventricular delay in patients with hypertrophic cardiomyopathy >50 years of age

Various treatment modalities have been introduced to reduce the subaortic pressure gradient in patients with obstructive hypertrophic cardiomyopathy, including pacemaker insertion. Complete ventricular capture during pacing is essential and requires optimization of the atrioventricular interval (AVI). In this study, a protocol using echocardiographic examination assessing the changes in the left ventricular outflow tract (LVOT) gradient in different AVIs, pacing rates, and pacing modes was used for optimal pacemaker programming. Twenty-five patients with obstructive hypertrophic cardiomyopathy were implanted with DDD pacemakers and evaluated prospectively. The LVOT gradient was measured during periodic evaluations every 3 to 6 months. Gradient measurements were done with 5 different AVIs and 3 different rate combinations. After each evaluation, the optimal AVI, pacing rate, and mode were set on the basis of the minimal LVOT gradient not associated with systolic arterial cuff pressure reduction. Follow-up ranged from 18 to 126 months. Peak LVOT gradient immediately decreased in 92% of patients. During follow-up, the optimal AVI was prolonged in most patients. Sixty-four percent of patients showed a clear relation between pacemaker modifications and gradient reduction. In 75% of these patients, optimal gradient reduction required repeated AVI and pacing rate programming on the basis of echocardiographic evaluation. Symptoms decreased in 92% of patients, and New York Heart Association class improved significantly (3.1+/-0.7 vs 1.3+/-0.4, p<0.001) during follow-up. The symptomatic reduction was positively correlated with the LVOT gradient reduction. In conclusion, DDD pacing is effective in reducing the LVOT gradient and improving functional capacity in adult patients with hypertrophic cardiomyopathy. Pacemaker programming with the periodic echocardiographic evaluation of the optimal AVI, pacing rate, and mode is imperative for optimal results.     

经皮室间隔心肌消融术治疗老年肥厚型梗阻性心肌病的临床分析

目的　探讨经皮室间隔心肌消融术治疗老年肥厚型梗阻性心肌病 (HOCM)的可行性 ,安全性和近期效果。方法　对 6 0岁以上的 6例老年HOCM患者施行心肌声学造影指导下的经皮室间隔心肌消融术治疗。结果　 6例患者的经皮室间隔心肌消融术均获成功 ,未出现严重的心脏并发症 ,术后即刻应用心导管测左室流出道压差由术前(10 4.33± 19.6 1)mmHg降至 (35± 2 5 .88)mmHg(P <0 .0 0 1)。术后对 6例患者进行了 1～ 18个月的随访 ,经超声心动图测左室流出道压差由术前 (91.83± 2 7.17)mmHg降至 (36 .0 8± 33.6 3)mmHg(P <0 .0 5 ) ,室间隔厚度由术前(2 1.83± 2 .79)mm降至 (16 .0 2± 3.86 )mm (P <0 .0 5 )。术后心功能由术前的 3.4± 0 .5级改善为 1.1± 0 .3级 (P <0 .0 0 1)。结论　经皮室间隔心肌消融术治疗老年HOCM患者的即刻和近期效果良好 ,并发症少 ,安全性高。     

Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: Acute results and three-year noninvasive follow-up in 18 patients

OBJECTIVES: To study the acute results and long-term clinical course after percutaneous transluminal septal myocardial ablation (PTSMA) in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS: In 18 patients (seven women, 11 men; average age 53+/-15 years) with symptomatic and medically refractory HOCM, 1.3+/-0.4 septal branches were occluded with an injection of 3.6+/-1.2 mL of 95% alcohol to ablate the hypertrophied interventricular septum. After three years, noninvasive follow-up results of clinical course, echocardiographic and electrocardiographic findings were determined. RESULTS: The invasively measured left ventricular outflow tract (LVOT) gradients were reduced in all patients, with a mean decrease from 79+/-21 mmHg to 11+/-8 mmHg at rest (P<0.01) and from 136+/-41 mmHg to 49+/-21 mmHg after extrasystole. All patients had angina pectoris for 8 h to 24 h. Eleven patients (61.1%) developed a trifascicular block for 3 min to four days requiring temporary (n=10 [56%]) or permanent dual chamber pacemaker implantation (n=1 [6%]). All patients were discharged after 5.9+/-2.3 days. Clinical, electrocardiographic and echocardiographic follow-up was achieved in all patients after three years (3.1+/-0.5 years). No cardiac complications occurred. Thirteen patients (72%) showed clinical improvement, with a New York Heart Association functional class of 1.5+/-0.8. A further reduction in LVOT gradient was shown in eight patients (44%). CONCLUSIONS: The LVOT gradient was greatly reduced in patients with HOCM undergoing a PTSMA procedure and their symptoms were greatly improved without cardiac complications during three-year follow-up. Possible complications include different degrees of heart block, such as trifascicular blocks, requiring temporary pacemaker implantation. PTSMA is a promising nonsurgical method for the treatment of symptomatic patients with HOCM. Clinical long-term follow-up of a larger series of patients is required to determine the therapeutic significance conclusively.     

Pacing for hypertrophic obstructive cardiomyopathy does it work?

Sixty-nine years old lady presented with sudden cardiac arrest, she was found to have hypertrophic obstructive cardiomyopathy, she refused septal myomectomy and had a dual chamber ICD implanted, she was put on right ventricular apical pacing with short AV interval, after pacing her max pressure gradient across left ventricular out flow tract (LVOT) dropped from 117 mmHg to 21 mmHg and her symptoms much improved over a follow up period of 1 year.     

Septal ethanol ablation for hypertrophic obstructive cardiomyopathy: early and intermediate results of a Canadian referral centre

BACKGROUND: Septal ethanol ablation (SEA) is a relatively new interventional nonsurgical treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM). This procedure involves targeted infarction of the basal interventricular septum to reduce left ventricular outflow tract (LVOT) obstruction. OBJECTIVES: To describe the experience with this technique in a large tertiary care centre. METHODS AND RESULTS: Since 1998, 40 HOCM patients with disabling symptoms refractory to medical treatment have undergone SEA. Procedural success was 88% (35 of 40 patients). The LVOT gradient decreased from 86+/-38 mmHg to 16+/-16 mmHg. There were two major complications: one patient died of respiratory failure at 30 days following SEA, and one patient developed a major coronary dissection during the procedure and required emergency myectomy and coronary bypass surgery. There were two late failures (6% of initially successful cases). In both patients, the LVOT gradient and symptoms reappeared some months after the procedure and further interventions were required. In the remaining patients, the gradient continued to decrease to one year; 86% were asymptomatic or have mild symptoms compared with 94% with severe symptoms before SEA. Septal thickness decreased from 20.8+/-2.9 mm to 13.2+/-3.3 mm (P<0.001) at the site of the targeted septal infarct. CONCLUSION: SEA is a feasible option for suitable patients with HOCM.     

Rare association of hypertrophic cardiomyopathy and complete atrioventricular block with prompt disappearance of outflow gradient after DDD pacing.

Although arrhythmias are common in hypertrophic cardiomyopathy (HCM), complete atrioventricular (AV) block is very unusual. A 27-year-old female presented with a recent history of syncope and exercise intolerance. ECG demonstrated complete AV block. Two-dimensional Doppler echocardiography revealed HCM with a 60 mmHg left ventricular outflow tract (LVOT) gradient. A temporary transvenous ventricular pacemaker was inserted urgently, and subsequently replaced by a permanent DDD pacemaker. All symptoms were eliminated. This symptomatic improvement was associated with complete disappearance of LVOT gradient at the time of implantation. No gradient was observed during early follow-up and at 6 months after DDD pacemaker implantation.     

Percutaneous transluminal septal myocardial ablation in drug-resistant hypertrophic obstructive cardiomyopathy: 18-month follow-up results.

OBJECTIVE: Surgery has been the only therapeutic option in patients with hypertrophic obstructive cardiomyopathy (HOCM) who are resistant to standard treatment. Percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced occlusion of the septal artery for the reduction of left ventricular outflow tract (LVOT) gradient is a novel method. However, long-term clinical follow-up is insufficient. This study reports the acute and mid-term results after PTSMA in symptomatic patients with HOCM. METHODS: Six patients (4 men and 2 women) with symptomatic HOCM and inadequate response to pharmacologic therapy had their major septal branches ablated with alcohol. Mean duration of follow-up was 1.5 years. RESULTS: There was reduction in LVOT gradient in all patients (100%) with a mean reduction of 50 mmHg. Two patients developed complete heart block (CHB) and 3 patients developed bifascicular block. CHB persisted in 1 patient. Two patients died within 8 days of the procedure; one due to cerebrovascular accident and 1 due to asystole. The patient who died of asystole had CHB but refused permanent pacemaker implantation. CHB reverted in 1 patient and bifascicular blocks persisted in 3 patients. Clinical and echocardiographic follow-up was achieved in the 4 surviving patients after 1.5 years. All surviving patients had LVOT gradient reduction and clinical improvement. CONCLUSION: PTSMA for HOCM is a non-surgical technique for reducing LVOT gradient. Heart blocks are one potential complication, and may require pacemaker implantation. Long-term follow-up and a larger series of patients are required to determine conclusive therapeutic significance.     

Alcohol drinking triggers acute myocardial infarction in a case of hypertrophic obstructive cardiomyopathy

Alcohol ingestion-related increased left ventricular outflow tract (LVOT) pressure gradient in hypertrophic obstructive cardiomyopathy (HOCM) has been reported in the literature; however, acute myocardial infarction (AMI) after alcohol drinking in this patient group is rarely reported. Herein, we report a 68-year-old man with chronic alcoholism suffering from AMI after alcohol drinking. Electrocardiography revealed complete left bundle branch block, and chest X-ray showed acute pulmonary edema. Intubation was done for respiratory failure and intra-aortic balloon pump was also inserted for unstable hemodynamics. However, emergent coronary angiography revealed normal coronary arteries. HOCM was diagnosed by a high pressure gradient over LVOT and systolic anterior motion of mitral valve by echocardiography. This patient became stable under intensive care and medical treatment. This case reminds physicians that alcohol ingestion might cause AMI in HOCM patients because of increased LVOT pressure gradient and decreased coronary perfusion despite normal coronary arteries.     

Impact of right atrial-left ventricular dual-chamber permanent pacing in patients with severely symptomatic hypertrophic obstructive cardiomyopathy.

BACKGROUND: Effective alternatives to surgical myectomy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) remain unestablished. Dual-chamber (DDD) pacing was evaluated in these patients using right atrial (RA) and epicardial left ventricular (LV) leads. METHODS AND RESULTS: In 6 patients with HOCM refractory to medical therapy and conventional RA-right ventricular (RV) DDD pacing, we implanted DDD pacemakers using RA and epicardial LV leads. The baseline intraventricular pressure gradient before pacemaker implantation was 103+/-44 mmHg. The pressure gradient decreased significantly to 8+/-16 mmHg by temporary RA-LV DDD pacing (p=0.006), while it decreased only to 68+/-25 mmHg by temporary RA-RV pacing (NS). It was nearly eliminated to 1+/-2 mmHg (p=0.027) 3 months after RA-LV DDD pacemaker implantation. LV end-diastolic pressure, cardiac index and systolic aortic pressure did not change significantly. New York Heart Association class improved in all patients (p=0.023). Brain and atrial natriuretic peptide concentrations, respectively 516+/-286 and 143+/-34 pg/ml at baseline, decreased significantly to 230+/-151 and 93+/-44 pg/ml 3 months after implantation (p=0.027 and 0.028). CONCLUSION: RA-LV DDD pacemaker implantation is a useful option for patients with symptomatic HOCM.     

Echocardiographic examination of atrioventricular and interventricular delay optimization in cardiac resynchronization therapy

In 21 patients implanted with a biventricular pacing device with programmable interventricular delay (VVd), the myocardial performance index (MPI) was evaluated during spontaneous sinus rhythm, simultaneous biventricular pacing, and sequential biventricular pacing at different VVds and atrioventricular delays (AVds). The AVd-VVd combination associated with the minimum MPI defined patient-tailored biventricular pacing. Simultaneous biventricular pacing significantly improved MPI compared with spontaneous sinus rhythm. An additional improvement was obtained by tailored biventricular pacing. The optimal AVds were significantly shorter during right ventricular preactivation than during left ventricular preactivation.     

超声心动图在肥厚型梗阻性心肌病中的应用

目的评价超声心动图在肥厚型梗阻性心肌病(HOCM)患者经皮室间隔化学消融术(PTSMA)治疗中的应用价值.方法应用超声心动图筛选HOCM患者17例,介入治疗术中引导及监测PTSMA,术后随访.结果术后即刻导管测量左心室流出道(LVOT)压差较术前减低,差异有统计学意义(P＜0.01).术后4周经胸超声心动图检查,LVOT压差、室间隔厚度和左心室射血分数均较术前明显减低,LVOT宽度均较术前明显增加,均差异有统计学意义(均P＜0.01).术前及术后超声心动图与导管测压所得参数具有良好的相关性(r=0.78;r=0.82,均P＜0.01).结论超声心动图技术可用于指导和监测HOCM患者的PTSMA治疗.     

Concurring hypertrophic cardiomyopathy and takotsubo cardiomyopathy: Assessment and management

The prevalence of takotsubo cardiomyopathy (TCM) has been on the rise, but co-occurrence with hypertrophic cardiomyopathy (HOCM) remains rare. Although presenting patient demographics were similar to those in TCM, the potential for hemodynamic compromise was significantly compounded by the presence of underlying HOCM. Management was similar to standalone TCM, although use of inotropic agents and mechanical support appears to be more prevalent. Despite the increased potential for complications and the paucity of data regarding management, outcomes appear to be mostly favorable in both the hospitalization period and at follow-up. Interestingly, despite a new diagnosis of HOCM in about half the cases described, which signifies no significant left ventricular outflow tract (LVOT) gradient prior to TCM, half of those patients had a persistently elevated LVOT gradient after resolution of TCM. This poses a question of whether or not TCM can predispose to LVOT obstruction in HOCM patients even after its resolution.     

Midventricular obstruction--a form of hypertrophic obstructive cardiomyopathy--and systolic anterior motion of the mitral valve

Hypertrophic cardiomyopathy (HCM) has various manifestations with respect to the localization of the hypertrophy. In this study we report clinical, electrocardiographic (ECG), echocardiographic (echo), and hemodynamic findings in midventricular obstruction (MO), an uncommon form of hypertrophic obstructive cardiomyopathy (HOCM) in 9 patients. The prevalence of systolic anterior motion of anterior mitral leaflet (SAM) in MO, an echocardiographic diagnostic hallmark in HOCM, was another purpose of this study. All patients had complete clinical, ECG, echo, and hemodynamic workup, including left ventricular (in 4 patients simultaneous biventricular, SBVA) and coronary angiograms. All patients had dyspnea and palpitations, chest pain, 2 had syncope. In the ECG, atrial fibrillation was present in 2, and left ventricular hypertrophy in 9 patients. Septal and left ventricular free wall thickening was significantly present in all patients in echo, and SAM in 1 patient. The intraventricular gradient (IVG) was 40-176 mmHg, in 1 case 40 mmHg by provocation, Brockenbrough was positive in all patients. Two patients had right ventricular IVG. A positive beta-blocking agent effect was present in 6 cases. The best localization of the obstruction was possible with SBVA and 2D-echo. We conclude that MO has all the signs of HOCM, but SAM in echocardiography is uncommon. SAM is occasionally present and is not a necessary factor to produce an intraventricular pressure gradient in HOCM, especially in MO. It seems that hypertrophic right ventricular obstruction is relatively common in MO (2 of 9 cases), and may have the same obstructive mechanism.     

Cardiac resynchronization therapy in acute pulmonary edema: A case report

We are reporting a case of 71-year old lady with a dual chamber demand pacemaker,who developed acute pulmonary edema due to an acute left ventricular(LV)dysfunction and worsening in mitral valve regurgitation after atrioventricular nodal ablation for uncontrolled atrial fibrillation.This was attributed to right ventricular apical pacing leading to LV dyssynchronization.Patient dramatically improved within 12-24 h after upgrading her single chamber pacemaker to biventricular pacing.Our case demonstrates that biventricular pacing can be an effective modality of treatment of acute congestive heart failure.In particular,it can be used when it is secondary to LV dysfunction and severe mitral regurgitation attributed to significant dyssynchrony created by right ventricular pacing in patients with atrioventricular nodal ablation for chronic atrial fibrillation.     

Is hydrotherapy an appropriate form of exercise for elderly patients with biventricular systolic heart failure?

Hydrotherapy (exercise in warm water) is considered to be a safe and beneficial method to use in the rehabilitation of stable heart failure patients, but there is little information on the effect of the increased venous return and enhanced preload in elderly patients with biventricular heart failure. We present a case report of an elderly man who was recruited to participate in a hydrotherapy study. We compared echocardiographic data during warm water immersion with land measurements, and observed increases in stroke volume from 32 mL (land) to 42 mL (water), left ventricular ejection fraction from 22 to 24%, left ventricular systolic velocity from 4.8 to 5.0 cm/s and left atrioventricular plane displacement from 2.1 to 2.2 mm. In opposite, right ventricular systolic velocity decreases from 11.2 to 8.4 cm/s and right atrioventricular plane displacement from 8.1 to 4.7 mm. The tricuspid pressure gradient rose from 18 mmHg on land to 50 mmHg during warm water immersion. Thus, although left ventricular systolic function was relatively unaffected during warm water immersion, we observed a decrease in right ventricular function with an augmented right ventricular pressure. We recommend further investigation to observe the cardiac effect of warm water immersion on patients with biventricular systolic heart failure and at risk of elevated right ventricular pressure.     

Plasma levels of brain natriuretic peptide in various forms of obstruction to the left ventricular outflow tract

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the relationship between plasma concentrations of brain natriuretic peptide (BNP) and the type or degree of stenosis in the left ventricular outflow tract (LVOT). METHODS: The relationship between BNP plasma level and pressure gradient (PG) in the LVOT and LV wall thickness (LVWth) was analyzed in 25 patients with a PG > or = 30 mmHg in the LVOT from the mid-left ventricle to the aortic valve. Among patients, 14 had aortic valve stenosis (AS), five had subaortic type hypertrophic obstructive cardiomyopathy (HOCM), three had mid-ventricular type HOCM, and three had angled ventricular septum. Three patients with AS showed LV systolic dysfunction (ejection fraction (EF) < 50%). All patients were in sinus rhythm. LV peak-systolic pressure (LVPSP) was derived by adding maximum PG to cuff systolic arterial pressure. RESULTS: In AS patients without LV systolic dysfunction and HOCM patients, there was a significant positive correlation between BNP and LVPSP (r = 0.78, p = 0.001; r = 0.76, p = 0.007, respectively). In AS patients without LV systolic dysfunction, BNP was positively correlated with LVWth (r = 0.79, p = 0.001), but no correlation was found between BNP and LVWth in patients with HOCM. In AS patients including systolic LV dysfunction, BNP was negatively correlated with LVEF (r = -0.87, p < 0.0001), but no correlation was found between BNP and LVEF in patients with HOCM. CONCLUSION: These results suggest that BNP level is closely associated with severity of stenosis in patients with HOCM, but mainly with severity of stenosis and also degree of LV systolic dysfunction in patients with AS. The BNP-LVWth relationship appeared to differ between AS (a fixed stenosis with uniform myocardial hypertrophy) and HOCM (a dynamic stenosis with uneven myocardial hypertrophy).