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Short- and long-term outcome after alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Experience of
Sílvia Aguiar Rosa1, António Fiarresga1, Ana Galrinho1
1Department of Cardiology, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal.
Insights
Alcohol septal ablation (ASA) effectively reduces the left ventricular outflow tract (LVOT) gradient in obstructive hypertrophic cardiomyopathy (HCM). Successful ASA improves symptoms and lowers the risk of cardiac death and rehospitalization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Obstructive hypertrophic cardiomyopathy (HCM) is a significant cause of heart failure.
- Alcohol septal ablation (ASA) is a minimally invasive procedure to reduce the left ventricular outflow tract (LVOT) gradient in obstructive HCM.
- Long-term outcomes of ASA in HCM patients are not well-established.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy (HCM).
- To assess the impact of ASA on left ventricular outflow tract (LVOT) gradient reduction and clinical outcomes.
Main Methods:
- A retrospective analysis of 80 patients who underwent ASA over a seven-year period in a tertiary center.
- Primary endpoints included >50% reduction in LVOT gradient, improvement in functional capacity (NYHA class), and a composite of cardiac death and rehospitalization for cardiac cause.
- Follow-up duration was 4.17±2.13 years.
Main Results:
- 85.7% of patients achieved the primary echocardiographic endpoint of >50% LVOT gradient reduction within a year.
- Significant reduction in LVOT gradient was observed at 3 and 6 months post-procedure (p<0.05).
- 77% of patients improved from NYHA class III/IV to I/II. The composite endpoint occurred in 22.7% of successful ASA patients versus 54.5% in unsuccessful cases.
Conclusions:
- Alcohol septal ablation (ASA) is a safe and effective procedure for managing obstructive hypertrophic cardiomyopathy (HCM).
- Significant LVOT gradient reduction post-ASA is associated with improved clinical outcomes and reduced cardiac mortality and rehospitalization.
- ASA offers a favorable long-term safety profile with a low rate of major complications.
Introduction:
In obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study.
Methods:
We analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years.
Results:
A total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker. The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes.
Conclusion:
ASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause.
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