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Conservative versus invasive treatment in hypertrophic obstructive cardiomyopathy: an echocardiography study
Insights
Alcohol septal ablation (ASA) significantly improves left ventricular outflow tract gradient and functional status in hypertrophic obstructive cardiomyopathy (HOCM) patients compared to conservative treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents challenges in managing left ventricular outflow tract obstruction and functional decline.
- Conservative management offers limited symptomatic relief for HOCM patients.
Purpose of the Study:
- To compare the long-term echocardiographic parameters and functional status in HOCM patients undergoing alcohol septal ablation (ASA) versus conservative treatment.
- To evaluate the impact of ASA on left ventricular remodeling and patient outcomes.
Main Methods:
- Prospective study comparing 41 HOCM patients treated conservatively with 39 HOCM patients treated with ASA.
- Echocardiographic parameters, including left ventricular outflow tract gradient (LVOTG), and New York Heart Association (NYHA) class were assessed over five years.
Main Results:
- ASA significantly reduced LVOTG at one and five years post-procedure compared to conservative treatment (p<0.001 and p<0.05, respectively).
- Patients in the ASA group showed a significant improvement in NYHA class at one, three, and five years compared to the conservative group (all p<0.001).
- A decline in LVOTG after ASA was associated with favorable left ventricle remodeling.
Conclusions:
- Alcohol septal ablation is superior to conservative treatment in improving functional status and reducing LVOTG in HOCM patients.
- ASA promotes beneficial left ventricular remodeling, leading to sustained functional improvement in HOCM.
- This study provides evidence for ASA as an effective interventional option for HOCM.
Aim And Methods:
The aim of our study was to compare the development of echocardiographic parameters and functional status of patients with hypertrophic obstructive cardiomyopathy (HOCM) treated conservatively (n = 41) or by alcohol septal ablation (ASA; n = 39).
Results:
Left ventricular outflow tract gradient (LVOTG) decreased in the first year by 53.7±36.4 mmHg in ASA group versus 5.5±47.1 mmHg in conservatively treated group (p<0.001), in the third year by 53.1±41.4 mmHg versus 23.9±42.7 mmHg (p = NS) and in the fifth year, the reduction of LVOTG was 52.1±44.5 mmHg in ASA group and 3.0±63.2 mmHg in conservatively treated group (p<0.05).Change in NYHA class in the first year was -1.1±0.4 versus 0.1±0.5, in the third year -1.0±0.6 versus 0.1±0.4 and in the fifth year -0.8±0.5 versus 0.1±0.4 (all p<0.001).
Conclusion:
Our results showed for the first time that decline of LVOTG after ASA creates a favorable left ventricle remodeling and leads to significant improvement of functional status of HOCM patients in comparison with conservative treatment (Tab. 3, Fig. 2, Ref. 42).
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