Obstruction after alcohol septal ablation is associated with cardiovascular mortality events
Josef Veselka1, Pavol Tomašov1, Jaroslav Januška2
1Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
Insights
Persistent left ventricular outflow tract obstruction (LVOTO) after alcohol septal ablation for hypertrophic cardiomyopathy (HCM) is linked to increased cardiovascular mortality. Early post-discharge LVOTO ≥30 mmHg predicts higher event rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left ventricular outflow tract obstruction (LVOTO) is a potential risk factor for long-term outcomes in hypertrophic cardiomyopathy (HCM).
- The impact of residual LVOTO on cardiovascular mortality after alcohol septal ablation (ASA) in obstructive HCM patients is not fully understood.
Purpose of the Study:
- To investigate the association between residual LVOTO after ASA and subsequent cardiovascular mortality events in patients with obstructive HCM.
Main Methods:
- A comparative study of patients undergoing ASA for obstructive HCM.
- Patients were categorized based on residual LVOTO (<30 mmHg vs. ≥30 mmHg) at the first post-discharge check-up (1-6 months).
- Outcomes, including freedom from cardiovascular mortality, were analyzed over a median follow-up of 5.1 years.
Main Results:
- 270 patients were included; 23% had residual LVOTO ≥30 mmHg post-ASA.
- Freedom from cardiovascular mortality was significantly lower in patients with residual LVOTO ≥30 mmHg at 1, 5, and 10 years (p<0.01).
- Early post-discharge LVOTO ≥30 mmHg (HR 2.95) and baseline septum thickness (HR 1.07) were independent predictors of cardiovascular mortality.
Conclusions:
- Residual LVOTO ≥30 mmHg at the first post-discharge assessment following ASA for obstructive HCM is significantly associated with increased cardiovascular mortality.
- Early identification and management of residual LVOTO may be crucial for improving long-term outcomes in these patients.
Background:
Left ventricular outflow tract obstruction (≥30 mm Hg at rest; LVOTO) is considered a possible risk of long-term outcomes in patients with hypertrophic cardiomyopathy (HCM). However, the influence of LVOTO on the occurrence of cardiovascular mortality events in patients after alcohol septal ablation (ASA) for obstructive HCM remains unresolved.
Methods:
We compared the outcomes of patients treated with ASA with residual LVOTO <30 mm Hg with those with residual LVOTO ≥30 mm Hg at the first postdischarge check-up (1-6 months after the procedure).
Results:
A total of 270 patients (60±12 years, median follow-up 5.1 years; 95% CI 4.5 to 5.9 years) treated with a single ASA were included; 208 (77%) and 62 (23%) patients had post-ASA LVOTO <30 and ≥30 mm Hg at the first postdischarge clinical check-up, respectively (LVOTO 13±6 vs 50±27 mm Hg; p<0.01). Freedom from cardiovascular mortality events at 1, 5 and 10 years were 99% (95% CI 96% to 100%) vs 94% (95% CI 85% to 98%), 95% (95% CI 89% to 97%) vs 80% (95% CI 66% to 89%) and 82% (95% CI 69% to 89%) vs 72% (95% CI 55% to 84%) (log-rank test, p<0.01), respectively. In multivariable analysis adjusted for age at ASA, sex, baseline LVOTO and baseline septum thickness, the independent predictors of cardiovascular mortality events were early postdischarge LVOTO ≥30 mm Hg (HR 2.95, 95% CI 1.26 to 6.91; p=0.01) and baseline septum thickness (HR 1.07, 95% CI 1.01 to 1.13; p=0.02).
Conclusions:
After ASA for obstructive HCM, LVOTO ≥30 mm Hg at the first postdischarge clinical check-up is associated with significantly higher occurrence of subsequent cardiovascular mortality events.
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