TY - JOUR
T1 - Outcomes of Alcohol Septal Ablation in Patients with Severe Left Ventricular Outflow Tract Obstruction
T2 - A Propensity Score Matching Analysis
AU - Veselka, Josef
AU - Liebregts, Max
AU - Cooper, Robert
AU - Faber, Lothar
AU - Januska, Jaroslav
AU - Hulikova Tesarkova, Klara
AU - Hansen, Peter Riis
AU - Seggewiss, Hubert
AU - Hansvenclova, Eva
AU - Bonaventura, Jiri
AU - Vejtasova, Veronika
AU - Ten Berg, Jurriën
AU - Stables, Rodney Hilton
AU - Jensovsky, Michael
N1 - Copyright © 2023. Published by Elsevier Inc.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - BACKGROUND: The current ACC/AHA guidelines on hypertrophic cardiomyopathy (HCM) caution that alcohol septal ablation (ASA) might be less effective in patients with left ventricular outflow tract obstruction (LVOTO) ≥ 100 mm Hg.METHODS: We used a multinational registry to evaluate the outcome of ASA patients according to baseline LVOTO.RESULTS: A total of 1346 ASA patients were enrolled and followed for 5.8 ± 4.7 years (7764 patient-years). The patients with baseline LVOTO ≥ 100 mm Hg were significantly older (61 ± 14 years vs 57 ± 13 years; P < 0.01), more often women (60% vs 45%; P < 0.01), and had a more pronounced HCM phenotype than those with baseline LVOTO < 100 mm Hg. There were no significant differences in the occurrences of 30-day major cardiovascular adverse events in the 2 groups. After propensity score matching (2 groups, 257 pairs of patients), the long-term survival was similar in both groups (P = 0.10), the relative reduction of LVOTO was higher in the group with baseline LVOTO ≥ 100 mm Hg (82 ± 21% vs 73 ± 26%; P < 0.01), but the residual resting LVOTO remained higher in this group (23 ± 29 mm Hg vs 13 ± 13 mm Hg; P < 0.01). Dyspnoea (NYHA functional class) at the most recent clinical check-up was similar in the 2 groups (1.7 ± 0.7 vs 1.7 ± 0.7; P = 0.85), and patients with baseline LVOTO ≥ 100 mm Hg underwent more reinterventions (P = 0.02).CONCLUSIONS: After propensity matching, ASA patients with baseline LVOTO ≥ 100 mm Hg had similar survival and dyspnoea as patients with baseline LVOTO < 100 mm Hg, but their residual LVOTO and risk of repeated procedures were higher.
AB - BACKGROUND: The current ACC/AHA guidelines on hypertrophic cardiomyopathy (HCM) caution that alcohol septal ablation (ASA) might be less effective in patients with left ventricular outflow tract obstruction (LVOTO) ≥ 100 mm Hg.METHODS: We used a multinational registry to evaluate the outcome of ASA patients according to baseline LVOTO.RESULTS: A total of 1346 ASA patients were enrolled and followed for 5.8 ± 4.7 years (7764 patient-years). The patients with baseline LVOTO ≥ 100 mm Hg were significantly older (61 ± 14 years vs 57 ± 13 years; P < 0.01), more often women (60% vs 45%; P < 0.01), and had a more pronounced HCM phenotype than those with baseline LVOTO < 100 mm Hg. There were no significant differences in the occurrences of 30-day major cardiovascular adverse events in the 2 groups. After propensity score matching (2 groups, 257 pairs of patients), the long-term survival was similar in both groups (P = 0.10), the relative reduction of LVOTO was higher in the group with baseline LVOTO ≥ 100 mm Hg (82 ± 21% vs 73 ± 26%; P < 0.01), but the residual resting LVOTO remained higher in this group (23 ± 29 mm Hg vs 13 ± 13 mm Hg; P < 0.01). Dyspnoea (NYHA functional class) at the most recent clinical check-up was similar in the 2 groups (1.7 ± 0.7 vs 1.7 ± 0.7; P = 0.85), and patients with baseline LVOTO ≥ 100 mm Hg underwent more reinterventions (P = 0.02).CONCLUSIONS: After propensity matching, ASA patients with baseline LVOTO ≥ 100 mm Hg had similar survival and dyspnoea as patients with baseline LVOTO < 100 mm Hg, but their residual LVOTO and risk of repeated procedures were higher.
KW - Cardiac Surgical Procedures
KW - Cardiomyopathy, Hypertrophic/complications
KW - Dyspnea/etiology
KW - Female
KW - Humans
KW - Propensity Score
KW - Retrospective Studies
KW - Treatment Outcome
KW - Ventricular Outflow Obstruction, Left
KW - Ventricular Outflow Obstruction/surgery
UR - http://www.scopus.com/inward/record.url?scp=85173219425&partnerID=8YFLogxK
U2 - 10.1016/j.cjca.2023.06.417
DO - 10.1016/j.cjca.2023.06.417
M3 - Journal article
C2 - 37355228
SN - 0828-282X
VL - 39
SP - 1622
EP - 1629
JO - The Canadian journal of cardiology
JF - The Canadian journal of cardiology
IS - 11
ER -