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Catheter-based septalablation for symptomatic hypertrophic obstructive cardiomyopathy:

Follow-up results of the TASH-registry of the German Cardiac Society

Katheter-basierte Septumablation bei symptomatischer hypertropher obstruktiver Kardiomyopathie: Follow-up—Ergebnisse des TASH-Registers der Deutschen Gesellschaft für Kardiologie

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Zusammenfassung

Einleitung

Im Herbst 1997 richtete die Deutsche Gesellschaft für Kardiologie ein bundesweites Register ein, das den Hospital- und mittelfristigen Verlauf bei mittels perkutaner Septumablation behandelten Patienten (Pat.) mit hypertropher obstruktiver Kardiomyopathie (HOCM) erfassen sollte. Die Analyse des Hospitalverlaufs liegt inzwischen vor. Wir berichten jetzt über den mittelfristigen Verlauf (3–6 Monate) der bis September 1999 eingeschlossenen Patienten.

Ergebnisse

Rückmeldungen lagen für 222 von 242 initial erfassten Pat. vor (92%). Im Follow-up-Zeitraum (4,9±2,3 Monate) verstarben 3 weitere Pat. (Hospitalmortalität: 3 Pat. (1,2%)). Über einen zufriedenstellenden Effekt der Intervention berichteten 195 Pat. (88%). Die akut erreichte Senkung des LVOT-Gradienten (LVOTG) von 57±31 auf 25±25 mmHg in Ruhe und von 107±53 auf 49±40 mmHg unter Provokation war nach 3–6 Monaten weiter akzentuiert (auf 20±21 mmHg in Ruhe bzw. 44±40 mmHg unter Provokation, p sämtlich <0,001), was für ein zeitabhängiges lokales Remodeling im Bereich der septalen Zielregion spricht. LA-Diameter (von 46±8 auf 44±7 mm), Septumdicke (von 20±5 auf 15±5 mm) und Dyspnoe, klassifiziert nach NYHA (von 2,8±0,7 auf 1,7±0,7) nahmen ebenfalls ab (p jew. <0,001). Interventionen unter Einschluss der intra-prozeduralen Echokardiographie sowie solche mit angiographisch/ durch Druckmessung erfolgender Steuerung waren hinsichtlich der klinischen Besserung und der invasiven Resultate vergleichbar.

Schlussfolgerung

Im mittelfristigen Verlauf nach Kathetertherapie, sowohl kontrastechokardiographisch wie auch per Druckmessung/fluoroskopisch gesteuert, bestätigen sich die positiven Akutergebnisse mit einem weiteren Absinken des LVOTG. LA-Last und Septumdicke nehmen ab, die körperliche Belastbarkeit nimmt weiter zu.

Summary

Introduction

In late 1997, the German Cardiac Society set up a multicenter registry to evaluate the acute and mid-term course of all patients (pts.) treated with septal ablation for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). An analysis of the acute results has already been published. We now report on the mid-term course (3–6 months) of 242 pts. registered through September 1999.

Results

Follow-up was 92% complete (n=222). During follow-up (mean: 4.9±2.3 months), an additional 3 pts. died (in-hospital mortality: 3 pts.). A satisfactory clinical effect was reported by 195 pts. (88%); 27 pts. (12%) remained in NYHA classes III and IV. Overall symptomatic improvement (NYHA class: from 2.8±0.7 to 1.7±0.7) paralleled the outflow gradient (LVOTG) reduction which was further accentuated as compared with the acute result (Doppler measurement at rest: from 57±31 to 25±25 mmHg to 20±21 mmHg; with provocation: from 107±53 to 49±40, to 44±40 mmHg, p<0.001, resp.). Left atrial (LA) diameter (from 46±8 to 44±7 mm) and septal thickness (from 20±5 to 15±5 mm; p<0.001, resp.) were also reduced. Comparing the methods for target vessel selection (i.e., with contrast echo monitoring vs pressurefluoroscopy guidance), at followup clinical improvement and hemodynamic measurements were comparable.

Conclusion

Clinical success can be achieved by septal ablation, both with the echocontrast guided and gradient-fluoroscopy guided method, in 88% of highly symptomatic HOCM pts. At mid-term follow-up, symptoms, left atrial size and septal thickness are reduced, and outflow gradients are further improved as compared to the acute result.

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Authors and Affiliations

  1. Kardiologische Klinik Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany

    L. Faber &  D. Horstkotte

  2. Leopoldina-Krankenhaus, 97422, Schweinfurt, Germany

    H. Seggewiss

  3. Klinik für Kardiologie, Herz- und Gefäß-Klinik Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany

    F. H. Gietzen

  4. Klinikum Bielefeld-Mitte, 33602, Bielefeld, Germany

    H. Kuhn

  5. Klinikum der Universität, Marchionini Straße 15, 81377, München-Großhadern, Germany

    P. Boekstegers

  6. Klinikum Kassel, Mönchebergstr. 41–43, 34125, Kassel, Germany

    L. Neuhaus†

  7. Medizinische Klinik/Kardiologie der Universität, Otfried-Müller-Straße 10, 72076, Tübingen, Germany

    L. Seipel

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  1. L. Faber
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  2. H. Seggewiss
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  3. F. H. Gietzen
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  4. H. Kuhn
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  5. P. Boekstegers
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  6. L. Neuhaus†
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  7. L. Seipel
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  8. D. Horstkotte
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Faber, L., Seggewiss, H., Gietzen, F.H. et al. Catheter-based septalablation for symptomatic hypertrophic obstructive cardiomyopathy:. ZS Kardiologie 94, 516–523 (2005). https://doi.org/10.1007/s00392-005-0256-8

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  • DOI: https://doi.org/10.1007/s00392-005-0256-8

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