Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry
Jazyk angličtina Země Anglie, Velká Británie Médium print-electronic
Typ dokumentu časopisecké články, multicentrická studie, pozorovací studie
PubMed
26746632
DOI
10.1093/eurheartj/ehv693
PII: ehv693
Knihovny.cz E-zdroje
- Klíčová slova
- Alcohol septal ablation, Prognosis, Survival,
- MeSH
- ablace metody mortalita MeSH
- ethanol terapeutické užití MeSH
- hypertrofická kardiomyopatie mortalita terapie MeSH
- Kaplanův-Meierův odhad MeSH
- lidé středního věku MeSH
- lidé MeSH
- přežití bez známek nemoci MeSH
- rizikové faktory MeSH
- rozpouštědla terapeutické užití MeSH
- srdeční septum MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- Názvy látek
- ethanol MeSH
- rozpouštědla MeSH
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.
Cardiocentre Podlesí Třinec Czech Republic
Department of Cardiology Gentofte Hospital Copenhagen University Hospital Hellerup Denmark
Department of Cardiology Heart and Diabetes Centre NRW Ruhr University Bochum Bad Oyenhausen Germany
Department of Cardiology Martini Hospital Groningen the Netherlands
Department of Cardiology Oslo University Hospital Oslo Norway
Department of Cardiology St Antonius Hospital Nieuwegein Nieuwegein the Netherlands
Department of Interventional Cardiology and Angiology Institute of Cardiology Warsaw Poland
Citace poskytuje Crossref.org
