Alcohol septal ablation in patients with severe septal hypertrophy
Josef Veselka1, Morten Jensen2, Max Liebregts3
1Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic veselka.josef@seznam.cz.
Insights
Alcohol septal ablation (ASA) is effective for hypertrophic obstructive cardiomyopathy (HOCM) even with severe left ventricular hypertrophy (IVS thickness ≥30 mm). While short-term outcomes are similar, long-term mortality is higher in the severe hypertrophy group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Current guidelines suggest alcohol septal ablation (ASA) is less effective for hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular hypertrophy.
- Systematic data supporting this statement are lacking.
- This study investigates the efficacy of ASA in HOCM patients with severe left ventricular hypertrophy.
Purpose of the Study:
- To test the statement that ASA is less effective in HOCM patients with severe left ventricular hypertrophy (basal interventricular septum thickness ≥30 mm).
- To compare short-term and long-term outcomes of ASA in patients with basal interventricular septum thickness <30 mm versus ≥30 mm.
Main Methods:
- Analysis of patients from the Euro-ASA registry.
- Comparison of short-term and long-term outcomes between patients with basal interventricular septum (IVS) thickness <30 mm and ≥30 mm treated with ASA.
- Follow-up duration of 5.4±4.3 years and 5.1±4.1 years for the respective groups.
Main Results:
- A total of 1519 patients were analyzed, with 67 (4.4%) having IVS thickness ≥30 mm.
- Short-term major adverse events were similar between groups.
- Long-term all-cause mortality was significantly higher in the IVS ≥30 mm group (p=0.047).
- No significant differences were observed in dyspnea, residual left ventricular outflow tract gradient, or need for repeated septal reduction procedures.
Conclusions:
- Alcohol septal ablation (ASA) provides similar short-term and long-term relief of symptoms and obstruction in hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular hypertrophy (basal IVS thickness ≥30 mm) compared to those with less severe hypertrophy.
- However, long-term all-cause and cardiac mortality rates are worse in patients with basal IVS thickness ≥30 mm.
- These findings suggest careful consideration of long-term risks in HOCM patients with severe hypertrophy undergoing ASA.
Objective:
The current guidelines suggest alcohol septal ablation (ASA) is less effective in hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular hypertrophy, despite acknowledging that systematic data are lacking. Therefore, we analysed patients in the Euro-ASA registry to test this statement.
Methods:
We compared the short-term and long-term outcomes of patients with basal interventricular septum (IVS) thickness <30 mm Hg to those with ≥30 mm Hg treated using ASA in nine European centres.
Results:
A total of 1519 patients (57±14 years, 49% women) with symptomatic HOCM were treated, including 67 (4.4%) patients with IVS thickness ≥30 mm. The occurrence of short-term major adverse events were similar in both groups. The mean follow-up was 5.4±4.3 years and 5.1±4.1 years, and the all-cause mortality rate was 2.57 and 2.94 deaths per 100 person-years of follow-up in the IVS <30 mm group and the IVS ≥30 mm group (p=0.047), respectively. There were no differences in dyspnoea (New York Heart Association class III/IV 12% vs 16%), residual left ventricular outflow tract gradient (16±20 vs 16±16 mm Hg) and repeated septal reduction procedures (12% vs 18%) in the IVS <30 mm group and IVS ≥30 mm group, respectively (p=NS for all).
Conclusions:
The short-term results and the long-term relief of dyspnoea, residual left ventricular outflow obstruction and occurrence of repeated septal reduction procedures in patients with basal IVS ≥30 mm is similar to those with IVS <30mm. However, long-term all-cause and cardiac mortality rates are worse in the ≥30 mm group.
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