Chang Su Min, Lakkis Nasser M, Franklin Jennifer, Spencer William H, Nagueh Sherif F
Department of Medicine, Section of Cardiovascular Medicine, University of Wisconsin, Madison, USA.
Circulation. 2004 Feb 24;109(7):824-7. doi: 10.1161/01.CIR.0000117089.99918.5A. Epub 2004 Feb 16.
Alcohol septal ablation (ASA) therapy results in clinical and hemodynamic improvement in patients with hypertrophic obstructive cardiomyopathy. However, a subset remains symptomatic afterward, requiring additional procedures. We sought to examine the determinants of an unsatisfactory outcome, defined as unchanged symptoms with <50% reduction of baseline left ventricular outflow tract (LVOT) gradient.
Of 173 consecutive hypertrophic obstructive cardiomyopathy patients who underwent ASA, 39 had an unsatisfactory outcome after the first procedure. Patients with an unsatisfactory outcome had a higher baseline LVOT gradient, fewer septal arteries injected with ethanol, lower peak creatine kinase (CK), smaller septal area opacified by contrast echocardiography, and higher residual gradient in the catheterization laboratory after ASA (all P<0.05). Symptoms, septal thickness, mitral regurgitation severity, and ventricular function were not determinants of outcome. On multiple logistic regression, LVOT gradient reduction after ASA in the catheterization laboratory to > or =25 mm Hg (OR, 5.5; P=0.01) and peak CK <1300 U/L (OR, 2.5; P=0.04) were the independent predictors of an unsatisfactory outcome.
The residual LVOT gradient in the catheterization laboratory and peak CK leak after ASA are the independent predictors of ASA outcome.
酒精间隔消融（ASA）治疗可使肥厚性梗阻性心肌病患者的临床症状和血流动力学得到改善。然而，仍有一部分患者术后仍有症状，需要进一步治疗。我们试图研究治疗效果不佳的决定因素，将其定义为症状无改善且左心室流出道（LVOT）梯度较基线降低<50%。
在173例连续接受ASA治疗的肥厚性梗阻性心肌病患者中，39例首次治疗后效果不佳。治疗效果不佳的患者基线LVOT梯度较高、注射乙醇的间隔动脉较少、肌酸激酶（CK）峰值较低、经对比超声心动图显示的间隔区域不透明度较小以及ASA后导管实验室中的残余梯度较高（均P<0.05）。症状、间隔厚度、二尖瓣反流严重程度和心室功能不是治疗效果的决定因素。多因素logistic回归分析显示，导管实验室中ASA后LVOT梯度降低至≥25 mmHg（比值比[OR]，5.5；P=0.01）和CK峰值<1300 U/L（OR，2.5；P=0.04）是治疗效果不佳的独立预测因素。
导管实验室中的残余LVOT梯度和ASA后的CK峰值渗漏是ASA治疗效果的独立预测因素。
