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Clinical Research in Cardiology

, Volume 107, Issue 6, pp 479–486 | Cite as

Risk marker profiles in patients treated with percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy

  • Amelie Burghardt
  • Frank van Buuren
  • Zisis Dimitriadis
  • Tim Grübbel
  • Hubert Seggewiss
  • Smita Scholtz
  • Dieter Horstkotte
  • Lothar Faber
Original Paper

Abstract

Background and study objective

Different studies have shown a good long-term survival with improvement of symptoms and hemodynamics after percutaneous septal ablation (PTSMA), similar to myectomy considered to be the therapeutic “gold standard” for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Furthermore, desobliteration of left ventricular (LV) outflow may modify features of the disease considered to be risk-relevant, such as magnitude of LV hypertrophy, outflow gradient, and left atrial (LA) size. The aim oft this study was to examine predictors of long-term mortality in a large cohort of patients with HOCM treated with PTSMA.

Methods and results

497 consecutive patients with symptomatic HOCM (mean age 55.4 ± 14.4 years, NYHA class: 2.9 ± 0.4) who underwent PTSMA between 1996 and 2014 were studied. Periprocedural mortality was 1% (five patients). During a follow-up time of 64.5 ± 53.2 months (range 0.1–207), 51 patients died, of these 25 due to cardiovascular problems, while 26 deaths were attributed to non-cardiac causes. Overall survival rates were 89.4% (± 1.7) after 5 and 80.6% (± 2.7) after 10 years. Among the baseline variables, advanced age, recurrent syncope, and magnitude of LV thickening were risk markers correlated to long-term post-procedural survival. The only mortality predictor that could be identified during follow-up was post-procedural NYHA class. Neither the other classical HCM risk markers nor other clinical or echocardiographic parameters predicted cardiac or all-cause mortality in this cohort.

Conclusions

Our findings suggest that the risk profile after septal ablation may differ from that of HOCM patients without an outflow desobliteration.

Keywords

Hypertrophic obstructive cardiomyopathy HOCM ICD Left ventricular outflow tract gradient Percutaneous septal ablation Sudden cardiac death 

Abbreviations

AV

Atrioventricular

CCS

Canadian Cardiovascular Society

CK

Creatine Kinase

CW

Continuous wave Doppler

EKG

Electrocardiogram

ESC

European Society of Cardiology

FS

Fractional shortening

H(O/N)CM

Hypertrophic (obstructive/non-obstructive) cardiomyopathy

HR

Hazard ratio

ICD

Implantable cardioverter defibrillator

IVS

Intraventricular septum

LA

Left atrium

LAD

Left anterior descending artery

LV

Left ventricle

LVEDD

Left ventricular end-diastolic diameter

LVOT

Left ventricular outflow tract

LVOTG

Left ventricular outflow tract gradient

LVOTO

Left ventricular outflow tract obstruction

MRI

Magnetic resonance imaging

nsVT

Non-sustained ventricular tachycardia

NYHA

New York Heart Association

PTSMA

Percutaneous transluminal septal myocardial ablation

SAM

Systolic anterior movement of the mitral valve

SCD

Sudden cardiac death

Notes

Acknowledgements

All authors have participated in the work and agree with the content of the article which contains data from the MD thesis of A. B. Parts of this work have been presented as abstract during the Annual Meeting of the German Cardiac Society 2015.

Compliance with ethical standards

Ethical standards

The study protocol was approved by the institutional review board (Ref.-#: 14/2014) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflicts of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Sigwart U (1995) Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet 346:211–214CrossRefPubMedGoogle Scholar
  2. 2.
    Braunwald E (1997) Induced septal infarction: a new therapeutic strategy for hypertrophic obstructive cardiomyopathy. Circulation 95:1981–1982CrossRefPubMedGoogle Scholar
  3. 3.
    Morrow AG, Reitz BA, Epstein SE, Henry WL, Conkle DM, Itscoitz SB, Redwood DR (1975) Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients. Circulation 52:88–102CrossRefPubMedGoogle Scholar
  4. 4.
    Maron BJ, Epstein SE, Morrow AG (1983) Symptomatic status and prognosis of patients after operation for hypertrophic obstructive cardiomyopathy: efficacy of ventricular septal myotomy and myectomy. Eur Heart J 4(Suppl F):175–185CrossRefPubMedGoogle Scholar
  5. 5.
    Ommen SR, Maron BJ, Olivotto I, Maron MS, Cecchi F, Betocchi S, Gersh BJ, Ackerman MJ, McCully RB, Dearani JA, Schaff HV, Danielson GK, Tajik AJ, Nishimura RA (2005) Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 46:470–476CrossRefPubMedGoogle Scholar
  6. 6.
    Schulte HD, Gramsch-Zabel H, Schwartzkopff B (1995) Hypertrophische obstruktive Kardiomyopathie: Chirurgische Behandlung. Schweiz Med Wochenschr 125:1940–1949PubMedGoogle Scholar
  7. 7.
    Watkins H, McKenna WJ (2005) The prognostic impact of septal myectomy in obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 46:477–479CrossRefPubMedGoogle Scholar
  8. 8.
    Leonardi RA, Kransdorf EP, Simel DL, Wang A (2010) Meta-analyses of septal reduction therapies for obstructive hypertrophic cardiomyopathy: comparative rates of overall mortality and sudden cardiac death after treatment. Circ Cardiovasc Interv 3:97–104CrossRefPubMedGoogle Scholar
  9. 9.
    Nagueh SF, Ommen SR, Lakkis NM, Killip D, Zoghbi WA, Schaff HV, Danielson GK, Quiñones MA, Tajik AJ, Spencer WH (2001) Comparison of ethanol septal reduction therapy with surgical myectomy for the treatment of hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 38:1701–1706CrossRefPubMedGoogle Scholar
  10. 10.
    Agarwal S, Tuzcu EM, Desai MY, Smedira N, Lever HM, Lytle BW, Kapadia SR (2010) Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy. J Am Coll Cardiol 55:823–834CrossRefPubMedGoogle Scholar
  11. 11.
    Seggewiss H, Rigopoulos A, Welge D, Ziemssen P, Faber L (2007) Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy. Clin Res Cardiol 96:856–863CrossRefPubMedGoogle Scholar
  12. 12.
    Rigopoulos AG, Daci S, Pfeiffer B, Papadopoulou K, Neugebauer A, Seggewiss H (2016) Low occurrence of ventricular arrhythmias after alcohol septal ablation in high-risk patients with hypertrophic obstructive cardiomyopathy. Clin Res Cardiol 105:953–961CrossRefPubMedGoogle Scholar
  13. 13.
    Faber L, Welge D, Fassbender D, Schmidt HK, Horstkotte D, Seggewiss H (2007) One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response. Clin Res Cardiol 96:864–873CrossRefPubMedGoogle Scholar
  14. 14.
    Faber L, Gleichmann U, Horstkotte D, Seggewiss H (2017) Catheter-based septal ablation for hypertrophic obstructive cardiomyopathy: long-term follow-up 1996–2016. Dtsch Med Wochenschr 142:276–281CrossRefPubMedGoogle Scholar
  15. 15.
    Seggewiss H, Gleichmann U, Faber L, Fassbender D, Schmidt HK, Strick S (1998) Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute results and 3-month follow-up in 25 patients. J Am Coll Cardiol 31:252–258CrossRefPubMedGoogle Scholar
  16. 16.
    Faber L, Seggewiss H, , Gietzen FH, Kuhn H, Boekstegers P, Neuhaus L, Seipel L, Horstkotte D (2005) Catheter-based septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: follow-up results of the TASH-registry of the German Cardiac Society. Z Kardiol 94: 516 – 23CrossRefPubMedGoogle Scholar
  17. 17.
    Faber L, Seggewiss H, Ziemssen P, Gleichmann U (1999) Intraprocedural myocardial contrast echocardiography as a routine procedure in percutaneous transluminal septal myocardial ablation: detection of threatening myocardial necrosis distant from the septal target area. Catheter Cardiovasc Interv 47:462–466CrossRefPubMedGoogle Scholar
  18. 18.
    Faber L, Welge D, Fassbender D, Schmidt HK, Horstkotte D, Seggewiss H (2007) Percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomopathy: managing the risk of procedure-related AV conduction disturbances. Int J Cardiol 119:163–167CrossRefPubMedGoogle Scholar
  19. 19.
    Faber L, Seggewiss H, Gleichmann U (1998) Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation 98:2415–2421CrossRefPubMedGoogle Scholar
  20. 20.
    Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS,. Naidu SS, Rick A. Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011) ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary. Circulation 124:2761–2796CrossRefPubMedGoogle Scholar
  21. 21.
    Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H, members ATF (2014) 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35:2733–2779CrossRefPubMedGoogle Scholar
  22. 22.
    Elliott PM, Poloniecki J, Dickie S, Sharma S, Monserrat L, Varnava A, Mahon NG, McKenna WJ (2000) Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 36:2212–2218CrossRefPubMedGoogle Scholar
  23. 23.
    Maron BJ, Spirito P, Shen WK, Haas TS, Formisano F, Link MS, Epstein AE, Almquist AK, Daubert JP, Lawrenz T, Boriani G, Estes NAM, Favale S, Piccininno M, Winters SL, Santini M, Betocchi S, Arribas F, Sherrid MV, Buja G, Semsarian C, Bruzzi P (2007) Implantable Cardioverter–defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA 298:405–412PubMedGoogle Scholar
  24. 24.
    Frommeyer G, Dechering DG, Zumhagen S, Löher A, Köbe J, Eckardt L, Reinke F (2016) Long-term follow-up of subcutaneous ICD systems in patients with hypertrophic cardiomyopathy: a single-center experience. Clin Res Cardiol 105:89–93CrossRefPubMedGoogle Scholar
  25. 25.
    Prinz C, Schwarz M, Ilic I, Laser KT, Lehmann R, Prinz EM, Bitter T, Vogt J, van Buuren F, Bogunovic N, Horstkotte D, Faber L (2013) Myocardial fibrosis severity on cardiac magnetic resonance imaging predicts sustained arrhythmic events in hypertrophic cardiomyopathy. Can J Cardiol 29:358–363CrossRefPubMedGoogle Scholar
  26. 26.
    Buck T, Breithardt OA, Faber L, Fehske W, Flachskampf FA, Franke A, Hagendorff A, Hoffmann R, Kruck I, Kücherer H, Menzel T, Pethig K, Tiemann K, Voigt JU, Weidemann F, Nixdorff U (2009) Manual zur Durchführung der Echokardiographie. Clin Res Cardiol 4:Suppl 1Google Scholar
  27. 27.
    Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in m-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1083CrossRefPubMedGoogle Scholar
  28. 28.
    Panza JA, Petrone RK, Fananapazir L, Maron BJ (1992) Utility of continuous wave doppler echocardiography in the noninvasive assessment of left ventricular outflow tract pressure gradient in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 19:91–99CrossRefPubMedGoogle Scholar
  29. 29.
    Watkins H (1994) Multiple disease genes cause hypertrophic cardiomyopathy. Br Heart J 72:4–9CrossRefGoogle Scholar
  30. 30.
    Niimura H, Bachinski LL, Sangwatanaroj S, Watkins H, Chudley AE, McKenna W, Kristinsson A, Roberts R, Sole M, Maron BJ, Seidman JG, Seidman CE (1998) Mutations in the gene for cardiac myosin-binding protein c and late-onset familial hypertrophic cardiomyopathy. N Engl J Med 338:1248–1257CrossRefPubMedGoogle Scholar
  31. 31.
    Maron MS, Olivotto I, Zenovich AG, Link MS, Pandian NG, Kuvin JT, Nistri S, Cecchi F, Udelson JE, Maron BJ (2006) Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation 114:2232–2239CrossRefPubMedGoogle Scholar
  32. 32.
    Spirito P, Bellone P, Harris KM, Bernabo P, Bruzzi P, Maron BJ (2000) Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med 342:1778–1785CrossRefPubMedGoogle Scholar
  33. 33.
    Maron MS, Olivotto I, Betocchi S, Casey SA, Lesser JR, Losi MA, Cecchi F, Maron BJ (2003) Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med 348:295–303CrossRefPubMedGoogle Scholar
  34. 34.
    Jensen MK, Prinz C, Horstkotte D, van Buuren F, Bitter T, Faber L, Bundgaard H (2013) Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: low incidence of sudden cardiac death and reduced risk profile. Heart 99:1012–1017CrossRefPubMedGoogle Scholar
  35. 35.
    Veselka L, Jensen MK, Liebregts M, Januska J, Krejci J, Bartel T, Dabrowski M, Hansen PR, Almaas VM, Seggewiss H, Horstkotte D, Tomasov P, Adlova R, Bundgaard H, Steggerda R, ten Berg J, Faber L (2016) Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry. Eur Heart J 37:1517–1523CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Amelie Burghardt
    • 1
  • Frank van Buuren
    • 1
  • Zisis Dimitriadis
    • 1
  • Tim Grübbel
    • 1
  • Hubert Seggewiss
    • 1
    • 2
  • Smita Scholtz
    • 1
  • Dieter Horstkotte
    • 1
  • Lothar Faber
    • 1
  1. 1.Clinic for Cardiology, Herz- und Diabeteszentrum NRWRuhr-Universität BochumBad OeynhausenGermany
  2. 2.Medical Clinic ILeopoldina HospitalSchweinfurtGermany

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