Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Circ Cardiovasc Interv. 2011 Jun;4(3):256-65. doi: 10.1161/CIRCINTERVENTIONS.110.959718. Epub 2011 May 3.
Single-center reports on percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy have shown considerable differences in outcome.
We report the long-term outcome of 313 PTSMA procedures performed in 279 patients with hypertrophic obstructive cardiomyopathy aged 59±14 years from 1999 to 2010 in 4 Scandinavian centers. Sixty-nine percent of patients had ≥1 comorbidity at baseline. The median (interquartile range) of left ventricular outflow tract gradient at rest was reduced from 58 mm Hg (34 to 89 mm Hg) at baseline to 12 mm Hg (8 to 24 mm Hg) at 1-year (P<0.001) and during Valsalva maneuver from 93 mm Hg (70 to 140 mm Hg) to 21 mm Hg (11 to 42 mm Hg) (P<0.001). The proportion of patients with syncope was reduced from 18% to 2% (P<0.001), and the proportion in New York Heart Association class III/IV was reduced from 94% to 21% (P<0.001). All treatment effects remained stable during the follow-up. New York Heart Association class III/IV at the most recent follow-up (2.9±2.6 years) was associated with diabetes mellitus (P=0.03), chronic obstructive pulmonary disease (P=0.02), and valve disease unrelated to hypertrophic cardiomyopathy (P<0.01). In-hospital mortality was 0.3%. The 1-, 5- and 10-year survival rates were 97%, 87%, and 67%, respectively (P=0.06 versus an age- and sex-matched background population) in all patients and 99%, 94%, and 88%, respectively (P=0.12) in patients aged <60 years (48±9 years, n=141). Age (hazard ratio, 1.07; 95% CI, 1.03 to 1.1) was the only predictor of survival.
In this multicenter study, the in-hospital mortality after PTSMA was low despite considerable comorbidities. The hemodynamic and symptomatic effects were sustained long term. The long-term symptomatic outcome was associated with baseline comorbidities. The 10-year survival rate was comparable to that in an age- and sex-matched background population, and age was the only predictor of survival.
经皮腔内间隔心肌消融术（PTSMA）治疗肥厚型梗阻性心肌病的单中心报告结果差异较大。
我们报告了 1999 年至 2010 年期间，4 个斯堪的纳维亚中心的 279 例年龄 59±14 岁的肥厚型梗阻性心肌病患者接受了 313 次 PTSMA 治疗的长期结果。69%的患者在基线时存在≥1 种合并症。静息时左心室流出道梯度中位数（四分位间距）从基线时的 58mmHg（34 至 89mmHg）降至 1 年时的 12mmHg（8 至 24mmHg）（P<0.001），在valsalva 动作时从 93mmHg（70 至 140mmHg）降至 21mmHg（11 至 42mmHg）（P<0.001）。晕厥患者比例从 18%降至 2%（P<0.001），纽约心脏协会（NYHA）心功能分级 III/IV 级的患者比例从 94%降至 21%（P<0.001）。在整个随访期间，所有治疗效果均保持稳定。最近随访（2.9±2.6 年）时 NYHA 心功能分级 III/IV 与糖尿病（P=0.03）、慢性阻塞性肺疾病（P=0.02）和与肥厚型心肌病无关的瓣膜病（P<0.01）相关。院内死亡率为 0.3%。所有患者的 1 年、5 年和 10 年生存率分别为 97%、87%和 67%（P=0.06 与年龄和性别匹配的背景人群相比），年龄<60 岁的患者（48±9 岁，n=141）的 1 年、5 年和 10 年生存率分别为 99%、94%和 88%（P=0.12）。年龄（危险比，1.07；95%CI，1.03 至 1.1）是唯一的生存预测因素。
在这项多中心研究中，尽管合并症较多，但 PTSMA 后的院内死亡率仍然较低。血流动力学和症状改善效果长期持续。长期症状改善与基线合并症相关。10 年生存率与年龄和性别匹配的背景人群相当，年龄是唯一的生存预测因素。
