Alcohol septal ablation for obstructive hypertrophic cardiomyopathy: outcomes in young, middle-aged, and elderly
Robert A Leonardi1, Jacob C Townsend, Chetan A Patel
1Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
Insights
Alcohol septal ablation (ASA) effectively treats obstructive hypertrophic cardiomyopathy (HCM) in all age groups. While safe for younger patients, elderly individuals experienced increased complications and numerically higher mortality with ASA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Obstructive hypertrophic cardiomyopathy (HCM) management guidelines vary by age.
- Surgical myectomy is often recommended for younger patients, while alcohol septal ablation (ASA) is considered for elderly patients.
- Limited evidence exists comparing ASA efficacy and safety across different age demographics.
Purpose of the Study:
- To compare the efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM).
- To evaluate outcomes of ASA in young, middle-aged, and elderly patient cohorts.
- To assess age-related differences in complication and mortality rates following ASA.
Main Methods:
- Prospective data collection and retrospective analysis of 389 alcohol septal ablations (ASAs) in 360 patients.
- Patients were stratified into three age groups: young (<45 years), middle-aged (45-64 years), and elderly (≥65 years).
- Comparison of baseline characteristics, left ventricular outflow tract gradients (LVOTGs), symptom improvement, complication rates, and mortality across age groups.
Main Results:
- Alcohol septal ablation (ASA) significantly improved left ventricular outflow tract gradients (LVOTGs) and dyspnea in all age groups.
- Improvements in LVOTGs and symptoms were comparable across young, middle-aged, and elderly patients at 12-month follow-up.
- Elderly patients (≥65 years) experienced significantly higher complication rates (20.8%) compared to younger and middle-aged patients (9.1% and 6.3%).
- Mortality rates were numerically higher in the elderly group, but this difference was not statistically significant.
Conclusions:
- Alcohol septal ablation (ASA) provides significant and similar symptom and hemodynamic improvements in obstructive hypertrophic cardiomyopathy (HCM) patients across all age groups.
- Elderly patients undergoing ASA face an increased risk of procedural complications.
- While not statistically significant, mortality risk was numerically higher in elderly patients, warranting careful consideration.
Objectives:
We compared the efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) in young, middle-aged, and elderly patients.
Background:
Intersociety guidelines suggest based on limited evidence that young patients with medically refractory symptoms of obstructive HCM should undergo surgical myectomy while elderly patients may be more appropriate for ASA.
Methods:
Data for 360 patients undergoing 389 ASAs were prospectively collected and retrospectively analyzed according to age.
Results:
Young (<45 years), middle-aged (45-64 years), and elderly (≥65 years) patients comprised 28, 40, and 32% of the study population, respectively. Young patients had thicker left ventricular septal walls at baseline, and elderly patients had more comorbidity and dyspnea. Resting, mean left ventricular outflow tract gradients (LVOTGs) were similar across the age groups at baseline (62, 66, and 68 mm Hg, respectively; P = NS for all comparisons). LVOTGs and dyspnea were significantly and similarly improved in all age groups immediately after ASA and through 12 months of follow-up (P < 0.001 for before and after comparisons; P = NS for intergroup comparisons). Complication rates were similar for young and middle-aged patients but higher for elderly patients (9.1 and 6.3% vs. 20.8%, respectively; P ≤ 0.016 for elderly vs. others). Mortality rates for young and middle-aged patients were lower than for elderly patients, but the differences were not statistically significant.
Conclusions:
Patients undergoing ASA had significant and similar improvements in LVOTGs and symptoms regardless of age. Procedural complications were increased in elderly patients, who had numerically but not statistically significantly higher mortality rates.
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