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Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry

J. Veselka, MK. Jensen, M. Liebregts, J. Januska, J. Krejci, T. Bartel, M. Dabrowski, PR. Hansen, VM. Almaas, H. Seggewiss, D. Horstkotte, P. Tomasov, R. Adlova, H. Bundgaard, R. Steggerda, J. Ten Berg, L. Faber,

. 2016 ; 37 (19) : 1517-23. [pub] 20160107

Jazyk angličtina Země Velká Británie

Typ dokumentu časopisecké články, multicentrická studie, pozorovací studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc18017366

AIMS: The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. METHODS AND RESULTS: We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 ± 36 to 16 ± 21 mmHg (P < 0.01) and NYHA class from 2.9 ± 0.5 to 1.6 ± 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class ≤2, which was independently associated with LV outflow tract gradient (P < 0.01). CONCLUSIONS: The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient.

Citace poskytuje Crossref.org

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$a Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry / $c J. Veselka, MK. Jensen, M. Liebregts, J. Januska, J. Krejci, T. Bartel, M. Dabrowski, PR. Hansen, VM. Almaas, H. Seggewiss, D. Horstkotte, P. Tomasov, R. Adlova, H. Bundgaard, R. Steggerda, J. Ten Berg, L. Faber,
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$a AIMS: The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. METHODS AND RESULTS: We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 ± 36 to 16 ± 21 mmHg (P < 0.01) and NYHA class from 2.9 ± 0.5 to 1.6 ± 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class ≤2, which was independently associated with LV outflow tract gradient (P < 0.01). CONCLUSIONS: The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient.
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$a Jensen, Morten Kvistholm $u Unit for Inherited Cardiac Diseases, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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$a Januska, Jaroslav $u Cardiocentre Podlesí, Třinec, Czech Republic.
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$a Krejci, Jan $u 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic.
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$a Bartel, Thomas $u Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria Cleveland Clinic, Abu Dhabi, United Arab Emirates.
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$a Dabrowski, Maciej $u Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
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$a Seggewiss, Hubert $u Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oyenhausen, Germany Department of Internal Medicine, Schweinfurt, Germany.
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$a Horstkotte, Dieter $u Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oyenhausen, Germany.
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