Risk marker profiles in patients treated with percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy
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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.
Our findings suggest that the risk profile after septal ablation may differ from that of HOCM patients without an outflow desobliteration.
KeywordsHypertrophic obstructive cardiomyopathy HOCM ICD Left ventricular outflow tract gradient Percutaneous septal ablation Sudden cardiac death
Canadian Cardiovascular Society
Continuous wave Doppler
European Society of Cardiology
Hypertrophic (obstructive/non-obstructive) cardiomyopathy
Implantable cardioverter defibrillator
Left anterior descending artery
Left ventricular end-diastolic diameter
Left ventricular outflow tract
Left ventricular outflow tract gradient
Left ventricular outflow tract obstruction
Magnetic resonance imaging
Non-sustained ventricular tachycardia
New York Heart Association
Percutaneous transluminal septal myocardial ablation
Systolic anterior movement of the mitral valve
Sudden cardiac death
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
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.
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