Abstract
Aim
The aim of this study was to analyze hemodynamic and clinical outcome in a cohort of 312 patients who were followed up over a period of 12 months after alcohol septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
Methods and results
PTSMA was intended in 337 patients with HOCM (mean age: 54±15 years), with 312 procedures completed by injection of 2.8±1.2 ml of alcohol. In 25 patients (8%) the intervention was aborted, mostly because of contrast echocardiographic findings. In the 312 patients who received alcohol, permanent pacing was necessary in 22 cases (7%); and in-hospital mortality was 1.3% (four patients). During follow-up, contact to six patients (2%) was lost, and three additional patients (1%) died. The 299 patients who either underwent non-invasive reassessment in our institution or transmitted followup data from their local physician formed the study population. Improvement in symptoms was reported by 272 patients (91%). Mean NYHA functional class was reduced from 2.9±0.4 to 1.5±0.7 (p<0.0001) along with a gradient reduction (echo-Doppler) from 59±32 to 8±15 mmHg at rest, and from 120±42 to 28±32 mmHg with provocation (p<0.0001 each). Exercise capacity improved from 94±51 to 119±40 watts (p=0.001), and peak oxygen consumption from 18±4 to 21±6 ml/ kg/min (p=0.01). Younger age and higher outflow gradients at baseline and immediately after intervention were associated with a less favorable hemodynamic outcome. The degree of limitation of exercise capacity at baseline was the only predictor of symptomatic improvement.
Conclusions
Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. In contrast to a previous study, in this cohort of 312 patients there was no association between post-interventional enzyme release and hemodynamic success. Younger patients with high baseline gradients, however, tended to have a less favorable hemodynamic outcome with higher residual gradients.
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References
Spirito P, Seidman CE, Mc Kenna WJ, Maron BJ (1997) The managemant of hypertrophic cardiomyopathy. New Engl J Med 336:775–785
Wigle DE, Rakowski H, Kimball BP, Williams WG (1995) Hypertrophic cardiomyopathy: Clinical spectrum and treatment. Circulation 92:1680–1692
Sigwart U (1995) Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet 346:211–214
Kimmelstiel CD, Maron BJ (2004) Role of percutaneous septal ablation in hypertrophic obstructive cardiomyopathy. Circulation 109:452–456
Knight CJ, Kurbaan AS, Seggewiss H, Henein M, Gunning M, Harrington D, Fassbender D, Gleichmann U, Sigwart U (1997) Non-surgical septal reduction for hypertrophic obstructive cardiomyopathy: Outcome in the first series of patients. Circulation 95:2075–2081
Kuhn H, Gietzen F, Leuner C, Gerenkamp T (1997) Induction of subaortic septal ischemia to reduce obstruction in hypertrophic obstructive cardiomyopathy. Eur Heart J 18:846–851
ACC/ESC (2003) Clinical Expert Consensus Document on HCM. Eur Heart J 24:1965–1991
Braunwald E (1997) Induced septal infarction: A new strategy for hypertrophic obstructive cardiomyopathy. Circulation 95:1981
Boekstegers P, Steinbigler P, Molnar A, Schwaiblmair M, Becker A, Knez A, Haberl R, Steinbeck G (2001) Pressure- guided nonsurgical myocardial reduction induced by small septal infarctions in hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 38:846–853
Faber L, Seggewiss H, Gleichmann U (1998) Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: Results with respect to intra-procedural myocardial contrast echocardiography. Circulation 98:2415–2421
Flores-Ramirez R, Lakkis NM, Middleton KJ, Killip D, Spencer WH 3rd, Nagueh SF (2001) Echocardiographic insights into the mechanisms of relief of left ventricular outflow tract obstruction after nonsurgical septal reduction therapy in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 37:208–214
Gietzen FH, Leuner CJ, Raute-Kreinsen U, Dellmann A, Hegselmann J, Strunk-Mueller C, Kuhn H (1999) Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Eur Heart J 20:1342–1354
Kuhn H, Seggewiss H, Gietzen FH, Boekstegers P, Neuhaus L, Seipel L (2004) Catheter-based therapy for hypertrophic obstructive cardiomyopathy: First in-hospital outcome analysis of the German TASH Registry. Z Kardiol 93:23–31
Lakkis NM, Nagueh SF, Kleiman NS, Killip DM, He ZX, Verani M, Roberts R, Spencer WH III (1998) Echocardiography- guided ethanol septal reduction for hypertrophic obstructive cardiomyopathy. Circulation 98:1750–1755
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-months follow-up in 25 patients. J Am Coll Cardiol 31:252–258
Seggewiss H (2001) Current status of alcohol septal ablation for patients with hypertrophic obstructive cardiomyopathy. Curr Cardiol Rep 3:160–166
Spencer WH 3rd, Roberts R (2000) Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: the need for a registry. Circulation 102:600–601
Faber L, Seggewiss H, Ziemssen P (2000) Targeting percutaneous transluminal septal ablation for HOCM by intra-procedural echocardiographic monitoring. J Am Soc Echocardiogr 13:1074–1079
Faber L, Meissner A, Ziemssen P, Seggewiss H (2000) Percutaneous transluminal septal myocardial ablation for HOCM: Long-term follow-up in the first series of 25 patients. Heart 83:326–331
Heric B, Lytle BW, Miller OP (1995) Surgical management of hypertrophic obstructive cardiomyopathy. J Thor Cardiovasc Surg 110:195–208
Schulte HD, Gramsch-Zabel H, Schwartzkopff B (1995) Hypertrophische obstruktive Kardiomyopathie: Chirurgische Behandlung. Schweiz Med Wochenschr 125:1940–1949
Schulte HD, Bircks W, Lösse B (1987) Techniques and complications of transaortic subvalvular myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM). Z Kardiol 76 (Suppl 3):145–151
Robbins RC, Stinson EB, Daily PO (1996) Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 111:586–594
Elliott PM, Poloniecki J, Dickie S, Sharma S, Monserrat M, Varnava A, Mahon NG, McKenna WJ (2000) Sudden death in HCM: Identification of high risk patients. J Am Coll Cardiol 36:2212–2218
Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, Shah PM, Spencer WH 3rd, Spirito P, Ten Cate FJ, Wigle ED, Vogel RA, Abrams J, Bates ER, Brodie BR, Danias PG, Gregoratos G, Hlatky MA, Hochman JS, Kaul S, Lichtenberg RC, Lindner JR, O’Rourke RA, Pohost GM, Schofield RS, Tracy CM, Winters WL Jr, Klein WW, Priori SG, Alonso-Garcia A, Blomstrom-Lundqvist C, De Backer G, Deckers J, Flather M, Hradec J, Oto A, Parkhomenko A, Silber S, Torbicki A (2003) American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol 42:1687–1713
Maron BJ, Nishimure RA, McKenna WJ et al (1999) Assessment of permanent dual-chamber pacing as treatment for drug refractory patients with obstructive HCM (M-PATHY). Circulation 99:2927–2933
Nagueh SF, Ommen SR, Lakkis NM, Killip D, Zoghbi WA, Schaff HV, Danielson GK, Quinones MA, Tajik JA, Spencer WH (2001) Comparison of ethanol septal reduction therapy with surgical myectomy for the treatment of hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 38:1707–1710
Qin JX, Shiota T, Lever HM, Kapadia SR, Sitges M, Rubin DN, Bauer F, Greenberg NL, Agler DA, Drinko JK, Martin M, Tuzcu EM, Smedira NG, Lytle B, Thomas JD (2001) Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery. J Am Coll Cardiol 38:1994–2000
Chang SM, Lakkis NM, Franklin J, Spencer WHIII, Nagueh SF (2004) Predictors of outcome after alcohol septal ablation therapy in patients with hypertrophic obstructive cardiomyopathy. Circulation 109:824–827
Faber L, Seggewiss H, Welge D, Fassbender D, Ziemssen P, Schmidt HK, Gleichmann U, Horstkotte D (2003) Vorhersage des Risikos permanenter atrioventrikulärer Überleitungsstörungen nach perkutaner Septumablation bei Patienten mit hypertropher obstruktiver Kardiomyopathie. Z Kardiol 92:39–45
Qin JX, Shiota T, Lever HM, Asher CR, Popovic ZB, Greenberg NL, Agler DA, Drinko JK, Smedira NG, Tuzcu EM, Lytle BW, Thomas JD (2004) Conduction system abnormalities in patients with obstructive hypertrophic cardiomyopathy following septal reduction interventions. Am J Cardiol 93:171–175
Veselka J, Duchonova R, Prochazkova S, Palenickova J, Sorajja P, Tesar D (2005) Effects of varying dosing in pecutaneous septal ablation for obstructive HCM on early hemodynamic changes. Am J Cardiol 95:675–678
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 (submitted)
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Faber, L., Welge, D., Fassbender, D. et al. 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, 864–873 (2007). https://doi.org/10.1007/s00392-007-0578-9
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DOI: https://doi.org/10.1007/s00392-007-0578-9