Kwon Deborah H, Kapadia Samir R, Tuzcu E Murat, Halley Carmel M, Gorodeski Eiran Z, Curtin Ronan J, Thamilarasan Maran, Smedira Nicholas G, Lytle Bruce W, Lever Harry M, Desai Milind Y
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
JACC Cardiovasc Interv. 2008 Aug;1(4):432-8. doi: 10.1016/j.jcin.2008.05.009.
We sought to assess outcomes of alcohol septal ablation (ASA) in high-risk patients.
Because surgical myectomy is the preferred treatment in patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) at our institution, we perform ASA in patients who are at high risk for surgery.
We studied 55 symptomatic HOCM patients (mean age 63 +/- 13 years, 67% women, mean follow-up 8 +/- 1 years), at high risk for surgery (as the result of age/comorbidities) who had ASA between 1997 and 2000. The following were recorded at baseline, 3 months, and 1 year: septal thickness, maximal (resting or provocable) left ventricular outflow tract gradient, Minnesota living with heart failure questionnaire score, and the presence of a permanent pacemaker. All-cause mortality was recorded.
No patients died at 48 h, 2 died at 1 year, 7 died at 5 years, and 13 died at 10 years. Only age >65 years at time of ASA predicted long-term mortality (log-rank p = 0.03). Mean maximal left ventricular outflow tract gradient (104 +/- 35 mm Hg vs. 49 +/- 28 mm Hg), septal thickness (2.4 +/- 0.4 cm vs. 1.8 +/- 0.6 cm), and Minnesota living with heart failure score (63 vs. 25) improved at 3 months, compared with baseline (all p < 0.001), with no significant changes at 1 year. New permanent pacemaker was present in 26% of patients.
In symptomatic HOCM patients who are at high risk for surgery, ASA is associated with symptomatic improvement and low short-term mortality; with long-term mortality only associated with older age at time of procedure. In symptomatic HOCM patients at high-risk for surgery, ASA is a viable option.
我们试图评估高危患者酒精间隔消融术（ASA）的疗效。
由于在我们机构有症状的肥厚性梗阻性心肌病（HOCM）患者中，手术切除肌部室间隔是首选治疗方法，因此我们对手术高危患者进行ASA。
我们研究了1997年至2000年间接受ASA的55例有症状的HOCM患者（平均年龄63±13岁，67%为女性，平均随访8±1年），这些患者因年龄/合并症而处于手术高危状态。在基线、3个月和1年时记录以下指标：室间隔厚度、最大（静息或激发状态下）左心室流出道压差、明尼苏达心力衰竭生活问卷评分以及永久性起搏器的植入情况。记录全因死亡率。
48小时内无患者死亡，1年时有2例死亡，5年时有7例死亡，10年时有13例死亡。仅ASA时年龄>65岁可预测长期死亡率（对数秩检验p = 0.03）。与基线相比，3个月时平均最大左心室流出道压差（104±35 mmHg对49±28 mmHg）、室间隔厚度（2.4±0.4 cm对1.8±0.6 cm）和明尼苏达心力衰竭生活评分（63对25）均有所改善（均p < 0.001），1年时无显著变化。26%的患者植入了新的永久性起搏器。
在有症状的手术高危HOCM患者中，ASA与症状改善和短期低死亡率相关；长期死亡率仅与手术时年龄较大有关。在有症状的手术高危HOCM患者中，ASA是一种可行的选择。
