Echocardiography. 2026 Aug;43(8):e70567. doi: 10.1111/echo.70567.
ABSTRACT
INTRODUCTION: Septal myectomy treats hypertrophic obstructive cardiomyopathy (HOCM), but its effect on myocardial deformation across cardiac chambers is incompletely defined. We evaluated chamber-specific strain remodeling 1 year after septal myectomy and examined whether atrial strain was associated with atrial fibrillation (AF) during follow-up.
METHODS: We retrospectively studied 187 consecutive patients undergoing surgical septal myectomy for HOCM. Conventional echocardiography and speckle-tracking strain analysis were used to assess left ventricular (LV), right ventricular (RV), left atrial (LA), and right atrial (RA) deformation preoperatively and at 1-year follow-up. Paired analyses compared preoperative and postoperative strain values. Multivariable logistic regression evaluated associations between baseline strain measures, AF, and all-cause mortality.
RESULTS: Among 187 patients, 85 had analyzable 1-year strain studies. At 1 year, LA contractile strain (CS) improved from 10.4±5.9% to 13.6±7.1% (p = 0.005), whereas LA reservoir strain (RS) did not significantly change. In contrast, RA-RS decreased from 36.0±10.6% to 28.0±11.6% (p = 0.001), RV free-wall strain worsened from -26.3±7.0% to -21.1±6.8% (p = 0.001), and RV global longitudinal strain (GLS) worsened from -21.3±5.1% to -17.3±5.5% (p = 0.001). LV-GLS was unchanged. Higher LA-CS was associated with lower odds of AF after adjustment (aOR 0.92, 95% CI 0.85-0.99; p = 0.018), as was higher LA-RS (aOR 0.95, 95% CI 0.91-0.99; p = 0.035). LA-RS was associated with mortality in unadjusted analysis but not after multivariable adjustment.
CONCLUSIONS: Septal myectomy is followed by nonuniform, chamber-specific deformation remodeling. LA-CS improves, LA-RS and CS identify patients at higher AF risk, LV-GLS remains unchanged, and right-sided longitudinal deformation worsens at 1 year. Four-chamber strain analysis may augment post-myectomy surveillance.
PMID:42518120 | PMC:PMC13411645 | DOI:10.1111/echo.70567