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Age-related hemodynamic and morphologic differences in patients undergoing alcohol septal ablation for hypertrophic
Josef Veselka1, Radka Duchonová, Jana Pálenícková
1Department of Cardiology, University Hospital Motol, Prague, Czech Republic. veselka.josef@seznam.cz
Insights
Alcohol septal ablation (ASA) effectively treats hypertrophic obstructive cardiomyopathy (HOCM) in all age groups. Younger patients with HOCM may have thicker septums and slower initial hemodynamic improvement after ASA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Alcohol septal ablation (ASA) is a treatment for highly symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
- The procedure aims to decrease the left ventricular (LV) outflow gradient and alleviate symptoms.
- This study investigates early changes in younger versus elderly HOCM patients undergoing ASA.
Purpose of the Study:
- To evaluate early hemodynamic, morphologic, and clinical changes after ASA in HOCM patients.
- To compare these changes between younger and elderly patient cohorts.
- To identify factors influencing outcomes post-ASA.
Main Methods:
- Forty-four HOCM patients (age 24-81) underwent ASA.
- Clinical and echocardiographic data were collected at baseline and up to 12 months post-procedure.
- Statistical analysis, including multivariate adjustment, was used to assess correlations and influences.
Main Results:
- A significant correlation was found between basal septum thickness and age at baseline and post-procedure.
- Septal thickness changes over follow-up were significantly influenced by age.
- A decrease in LV outflow gradient was observed in all age groups, influenced by age and peak creatine kinase-MB levels.
Conclusions:
- ASA is an effective HOCM treatment regardless of patient age.
- Younger patients present with thicker basal septums and experience slower early hemodynamic improvement post-ASA.
- Age and peak creatine kinase-MB are significant factors in the hemodynamic response to ASA.
Background:
Alcohol septal ablation (ASA) decreases the left ventricular (LV) outflow gradient and relieves symptoms in patients with highly symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study was to evaluate the early course of hemodynamic, morphologic and clinical changes in younger and elderly patients.
Methods And Results:
Forty-four consecutive patients (age, 24-81 years) underwent the ASA procedure for HOCM. Clinical and echocardiographic data were obtained at baseline and periodically up to 12 months after ASA. There was a significant correlation between septum thickness and age at baseline and in the early post procedural period (p = 0.004 at baseline, p = 0.0033 days postoperative, p = 0.0193 weeks pos operative). The dependence of septal thickness on the duration of follow-up (p < 0.001) was significantly influenced by age (p = 0.026), which retained statistical significance after multivariate adjustment (p = 0.031). A decrease in the gradient of the LV outflow was identified in all age-related groups of patients (p < 0.001). After multivariate adjustment, there was a significant influence of age (p = 0.003) and creatine kinase-MB peak (p = 0.016) on the course of outflow gradient reduction.
Conclusions:
ASA is an effective treatment option for patients with HOCM, irrespective of their age. Younger patients are characterized by a thicker basal septum at baseline and a slower hemodynamic improvement within the early post procedural period.
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