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.

Cardiocentre Podlesi Trinec Czech Republic

Comprehensive Heart Failure Centre University Clinic Wuerzburg Wuerzburg Germany

Department of Cardiology 2nd Medical School Charles University University Hospital Motol Prague Czech Republic

Department of Cardiology Herlev and Gentofte Hospital Hellerup Denmark

Department of Cardiology St Antonius Hospital Nieuwegein Nieuwegein The Netherlands

Department of Demography and Geodemography Faculty of Science Charles University Prague Czech Republic

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

Institute of Cardiovascular Medicine and Science Liverpool Heart and Chest Hospital Liverpool England United Kingdom

Ruhr University Bochum Bochum Germany

Can J Cardiol. 2024 Jan;40(1):56. doi: 10.1016/j.cjca.2023.07.010. PubMed

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