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Outcomes of Alcohol Septal Ablation in Patients With Severe Left Ventricular Outflow Tract Obstruction: A Propensity Score Matching Analysis

J. Veselka, M. Liebregts, R. Cooper, L. Faber, J. Januska, KH. Tesarkova, PR. Hansen, H. Seggewiss, E. Hansvenclova, J. Bonaventura, V. Vejtasova, J. Ten Berg, RH. Stables, M. Jensovsky

. 2023 ; 39 (11) : 1622-1629. [pub] 20230622

Language English Country England, Great Britain

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc24000915

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.

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$a Veselka, Josef $u Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic. Electronic address: veselka.josef@seznam.cz
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$a Outcomes of Alcohol Septal Ablation in Patients With Severe Left Ventricular Outflow Tract Obstruction: A Propensity Score Matching Analysis / $c J. Veselka, M. Liebregts, R. Cooper, L. Faber, J. Januska, KH. Tesarkova, PR. Hansen, H. Seggewiss, E. Hansvenclova, J. Bonaventura, V. Vejtasova, J. Ten Berg, RH. Stables, M. Jensovsky
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$a 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.
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$a Liebregts, Max $u Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
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$a Cooper, Robert $u Department of Sports and Exercise Medicine, John Moores University, Liverpool, England, United Kingdom; Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, England, United Kingdom
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$a Faber, Lothar $u Ruhr-University Bochum, Bochum, Germany
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$a Januska, Jaroslav $u Cardiocentre Podlesi, Trinec, Czech Republic
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$a Tesarkova, Klara Hulikova $u Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czech Republic
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$a Hansen, Peter Riis $u Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
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$a Seggewiss, Hubert $u Comprehensive Heart Failure Centre, University Clinic Wuerzburg, Wuerzburg, Germany
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$a Hansvenclova, Eva $u Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
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$a Bonaventura, Jiri $u Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
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$a Vejtasova, Veronika $u Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
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$a Ten Berg, Jurriën $u Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
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$a Stables, Rodney Hilton $u Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, England, United Kingdom
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$a Jensovsky, Michael $u Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
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