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Short- and long-term outcomes of alcohol septal ablation for hypertrophic obstructive cardiomyopathy in patients with mild left ventricular hypertrophy: a propensity score matching analysis

Published on Jun 1, 2019in European Heart Journal23.239
· DOI :10.1093/eurheartj/ehz110
Josef Veselka22
Estimated H-index: 22
(Charles University in Prague),
Lothar Faber31
Estimated H-index: 31
(RUB: Ruhr University Bochum)
+ 11 AuthorsMorten Kvistholm Jensen9
Estimated H-index: 9
(Copenhagen University Hospital)
Abstract
  • References (24)
  • Citations (1)
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References24
Newest
#1Angelos G. Rigopoulos (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 15
#2S. Sakellaropoulos (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 2
Last. Michel Noutsias (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 32
view all 7 authors...
Transcatheter alcohol septal ablation (ASA) treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) is based on the existence and degree of intraventricular obstruction. Patients with significant gradient and symptoms who do not respond to optimal medical therapy are eligible to gradient reduction through a surgical (septal myectomy) or a transcatheter (alcohol septal ablation) septal reduction. The latter encompasses occlusion of a septal branch perfusing the hyper...
7 CitationsSource
#1Anita Nguyen (Mayo Clinic)H-Index: 4
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 108
Last. Steve R. Ommen (Mayo Clinic)H-Index: 60
view all 7 authors...
10 CitationsSource
#1Josef Veselka (Charles University in Prague)H-Index: 22
#2Lothar Faber (RUB: Ruhr University Bochum)H-Index: 31
Last. Max LiebregtsH-Index: 9
view all 16 authors...
Abstract Background The current American College of Cardiology Foundation/American Heart Association guidelines on hypertrophic cardiomyopathy state that institutional experience is a key determinant of successful outcomes and lower complication rates of alcohol septal ablation (ASA). The aim of this study was to evaluate the safety and efficacy of ASA according to institutional experience with the procedure. Methods We retrospectively evaluated 1310 patients with symptomatic obstructive hypertr...
10 CitationsSource
#1Josef Veselka (Charles University in Prague)H-Index: 22
#2Nandan S. Anavekar (Mayo Clinic)H-Index: 20
Last. Philippe Charron (University of Paris-Sud)H-Index: 17
view all 3 authors...
Summary Hypertrophic obstructive cardiomyopathy is an inherited myocardial disease defined by cardiac hypertrophy (wall thickness ≥15 mm) that is not explained by abnormal loading conditions, and left ventricular obstruction greater than or equal to 30 mm Hg. Typical symptoms include dyspnoea, chest pain, palpitations, and syncope. The diagnosis is usually suspected on clinical examination and confirmed by imaging. Some patients are at increased risk of sudden cardiac death, heart failure, and a...
39 CitationsSource
#1Josef Veselka (Charles University in Prague)H-Index: 22
#2Pavol Tomašov (Charles University in Prague)H-Index: 11
Last. Radka Adlová (Charles University in Prague)H-Index: 9
view all 5 authors...
Background Left ventricular outflow tract obstruction (≥30 mm Hg at rest; LVOTO) is considered a possible risk of long-term outcomes in patients with hypertrophic cardiomyopathy (HCM). However, the influence of LVOTO on the occurrence of cardiovascular mortality events in patients after alcohol septal ablation (ASA) for obstructive HCM remains unresolved. Methods We compared the outcomes of patients treated with ASA with residual LVOTO <30 mm Hg with those with residual LVOTO ≥30 mm Hg at the fi...
14 CitationsSource
Background— We assessed the influence of interventricular septal thickness (IVSd) on the clinical outcome and survival after alcohol septal ablation (ASA) in patient with hypertrophic cardiomyopathy. Methods and Results— We analyzed 531 patients with hypertrophic cardiomyopathy (age: 56±14 years, men 55%) treated with ASA. Survival status was obtained 7.9±4.0 years after ASA. Baseline IVSd was inversely associated with survival (hazard ratio [HR] for 1 mm increment, 1.13; confidence interval, 1....
2 CitationsSource
#1Luke K. Kim (NewYork–Presbyterian Hospital)H-Index: 16
#2Rajesh V. Swaminathan (NewYork–Presbyterian Hospital)H-Index: 18
Last. Dmitriy N. Feldman (NewYork–Presbyterian Hospital)H-Index: 23
view all 11 authors...
Importance Previous data on septal myectomy (SM) and alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy have been limited to small, nonrandomized, single-center studies. Use of septal reduction therapy and the effect of institutional experience on procedural outcomes nationally are unknown. Objective To examine in-hospital outcomes after SM and ASA stratified by hospital volume within a large, national inpatient database. Design, Setting, and Participants This study analyze...
68 CitationsSource
#1Josef Veselka (Charles University in Prague)H-Index: 22
#2Morten Kvistholm Jensen (Copenhagen University Hospital)H-Index: 9
Last. Lothar Faber (RUB: Ruhr University Bochum)H-Index: 31
view all 17 authors...
Aims The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. Methods and results We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symp...
60 CitationsSource
#1Max LiebregtsH-Index: 9
#2Guus M. Bol (UU: Utrecht University)H-Index: 9
Last. Jurriën M. ten BergH-Index: 52
view all 6 authors...
3 CitationsSource
Abstract Background In severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM) and mild septal hypertrophy, mitral valve (MV) abnormalities may play an important role in MV displacement into the left ventricular (LV) outflow tract. Therefore, isolated myectomy may not relieve outflow obstruction and symptoms, and MV replacement is often the surgical alternative. Objectives This study sought to assess the clinical and hemodynamic results of cutting thickened secondary MV ...
53 CitationsSource
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#1C. Vaughan Tuohy (OHSU: Oregon Health & Science University)H-Index: 1
#2Sanjiv Kaul (OHSU: Oregon Health & Science University)H-Index: 82
Last. Stephen Heitner (OHSU: Oregon Health & Science University)H-Index: 7
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Hypertrophic cardiomyopathy (HCM) is a heterogeneous genetic disorder most often caused by sarcomeric mutations resulting in left ventricular hypertrophy, fibrosis, hypercontractility, and reduced compliance. It is the most common inherited monogenic cardiac condition, affecting 0.2% of the population. Whereas currently available therapies for HCM have been effective in reducing morbidity, there remain important unmet needs in the treatment of both the obstructive and non-obstructive phenotypes....
2 CitationsSource
#1Thomas F. Lüscher (UZH: University of Zurich)H-Index: 123
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