[Efficacy comparison between conservative therapy and septal ablation in patients with hypertrophic obstructive
1*Department of Cardiology, Anzhen Hospital Affiliated to Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China.
Insights
Septal ablation (SA) significantly improves hemodynamics and clinical status in hypertrophic obstructive cardiomyopathy (HOCM) patients resistant to medication. SA offers a higher overall survival rate compared to conservative medication (CM) without increasing sudden cardiac death risk.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents significant hemodynamic and clinical challenges.
- Current management often involves conservative medication (CM), but outcomes can be suboptimal for drug-resistant cases.
Purpose of the Study:
- To compare the efficacy of septal ablation (SA) against conservative medication (CM) in managing HOCM.
- To evaluate the impact of SA on hemodynamic parameters, clinical status, and patient survival.
Main Methods:
- A retrospective study of 350 HOCM patients over 14 years.
- Comparison of overall and cardiac-related mortality between SA and CM groups.
- Analysis of SA's effect on left ventricular outflow tract (LVOT) gradient and New York Heart Association (NYHA) functional class.
Main Results:
- Septal ablation significantly reduced LVOT gradient (peak velocity from 4.23 to 1.83 m/s) and improved NYHA class (from 2.97 to 1.74).
- Annual mortality was lower in the SA group (2.4%) compared to the CM group (0.6%) (P<0.001).
- Cumulative sudden cardiac death (SCD) rates were 3.61% for SA vs. 0.54% for CM (P=0.031), with age identified as an independent predictor of overall mortality.
Conclusions:
- Septal ablation is effective in improving hemodynamics and clinical status for HOCM patients refractory to medication.
- SA demonstrates a significantly higher overall survival rate compared to CM, without an increased risk of SCD.
Abstract:
Objective: To compare the effects of septal ablation (SA) versus conservative medication (CM) on the hemodynamic, clinical status and survival in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: This retrospective study included 350 consecutive patients with HOCM (mean age (51.3±13.5) years old) hospitalized in Anzhen Hospital between September 2002 to September 2014. The patients were followed up to 14 years and the follow up rate was 99.4% (348/350). Overall and cardiac-related mortalities were compared between SA group (n=184) and CM group (n=184). Moreover, SA related cardiac function and hemodynamics improvement were also evaluated, predictors for clinical events were evaluated by Cox regression analysis and Kaplan-Meier survival analysis was used to compare the total mortality between the two groups. The log-rank test was used to compare the survival curve differences between the two groups. Results: The median follow-up period was 4 years (1-14 years). The annual mortalities of SA and CM were 2.4% and 0.6% respectively (P<0.001) and cumulative sudden cardiac death (SCD)rates were 3.61% (6/166) and 0.54% (1/184) respectively (P=0.031). Multivariate regression analysis demonstrated that the age was the most important independent predictor for overall mortality(HR=1.259, 95%CI 1.101-1.438, P=0.001). In addition, left ventricular outflow tract (LVOT) gradient was significantly reduced post SA (peak velocity of LVOT: baseline (4.23±1.05) m/s, post SA: (1.83±0.79) m/s, P<0. 01) and heart function was also significantly improved post SA (NYHA at baseline: 2.97±0.29, post SA: 1.74±0.53, P<0.001). Conclusion: SA could significantly improve the hemodynamics and clinical status in drug-resistant patients with HOCM. In comparison to patients received CM, overall survival rate was significantly higher in SA group without extra risk of SCD.
More Related Videos
08:42Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
14:39Isolation and Functional Characterization of Human Ventricular Cardiomyocytes from Fresh Surgical Samples
Published on: April 21, 2014
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System