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Studies on the pathophysiological mechanism of hypertrophic cardiomyopathy

Ahmed, Ibrar (2017)
Ph.D. thesis, University of Birmingham.

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Abstract

Background
Treatment options for patients with symptomatic non-obstructive HCM are limited, driving a need to develop novel treatment strategies.

Objectives
To investigate the effects of biventricular pacing on symptom status and exercise capacity in patients with symptomatic non-obstructive Hypertrophic Cardiomyopathy and explore the mechanism of benefit.

Methods
31 patients with symptomatic, exercise limited non-obstructive Hypertrophic Cardiomyopathy were enrolled into this double blind randomised cross over study of Biventricular vs sham pacing. The primary end point was peak oxygen consumption.

Results
29 patients successfully completed the study. Biventricular pacemaker therapy increased peak Oxygen consumption (1.17ml/kg/min) and improved quality of life, without effects on systolic or diastolic mechanical dyssynchrony. A subset of patients in whom left ventricular diastolic volume fell on exercise (n = 15) achieved a greater increase in peak Oxygen consumption vs. those in whom left ventricular diastolic volume increased (1.4 vs. 0.91ml/kg/min p = 0.03) and this was associated with a normalisation of the left ventricular diastolic volume response to exercise.

Conclusions
Severely symptomatic patients with non-obstructive Hypertrophic Cardiomyopathy may benefit from Biventricular pacing. The mechanism of benefit from this treatment modality was a profound improvement of diastolic filling on exercise potentially due to amelioration of diastolic ventricular interaction.

Type of Work:Ph.D. thesis.
Supervisor(s):Frenneaux, Michael and Marshall, Janice
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:Institute of Cardiovascular Sciences
Additional Information:

Publications arising from thesis:

Abstract 4344: Biventricular Pacemaker Therapy Corrects Dyssynchrony in Non-Obstructive Hypertrophic Cardiomyopathy
Ibrar Ahmed, Khalid Abozguia, Ganesh Nallur-Shivu, Thanh T Phan, Abdul Maher, Berthold Stegemann, Rodolphe Katra, Kiran Patel, Francisco Leyva, John Sanderson, Denis Pellerin, Perry Elliott and Michael Frenneaux
Circulation. 2008;118:S_869, originally published January 18, 2016
http://circ.ahajournals.org/content/118/Suppl_18/S_869.1.short

Subjects:QH301 Biology
RC Internal medicine
Institution:University of Birmingham
ID Code:7367
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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