Methodist DeBakey Heart and Vascular Center, 6550 Fannin, Houston, TX 77030 USA.
J Am Coll Cardiol. 2011 Nov 22;58(22):2322-8. doi: 10.1016/j.jacc.2011.06.073.
The purpose of the study is to identify the predictors of clinical outcome (mortality and survival without repeat septal reduction procedures) of alcohol septal ablation for the treatment of patients with hypertrophic obstructive cardiomyopathy.
Alcohol septal ablation is used for treatment of medically refractory hypertrophic obstructive cardiomyopathy patients with severe outflow tract obstruction. The existing literature is limited to single-center results, and predictors of clinical outcome after ablation have not been determined. Registry results can add important data.
Hypertrophic obstructive cardiomyopathy patients (N = 874) who underwent alcohol septal ablation were enrolled. The majority (64%) had severe obstruction at rest, and the remaining had provocable obstruction. Before ablation, patients had severe dyspnea (New York Heart Association [NYHA] functional class III or IV: 78%) and/or severe angina (Canadian Cardiovascular Society angina class III or IV: 43%).
Significant improvement (p < 0.01) occurred after ablation (~5% in NYHA functional classes III and IV, and 8 patients in Canadian Cardiovascular Society angina class III). There were 81 deaths, and survival estimates at 1, 5, and 9 years were 97%, 86%, and 74%, respectively. Left anterior descending artery dissections occurred in 8 patients and arrhythmias in 133 patients. A lower ejection fraction at baseline, a smaller number of septal arteries injected with ethanol, a larger number of ablation procedures per patient, a higher septal thickness post-ablation, and the use beta-blockers post-ablation predicted mortality.
Variables that predict mortality after ablation, include baseline ejection fraction and NYHA functional class, the number of septal arteries injected with ethanol, post-ablation septal thickness, beta-blocker use, and the number of ablation procedures.
本研究旨在确定酒精间隔消融术治疗肥厚型梗阻性心肌病患者的临床结果（死亡率和无需再次行间隔缩减术的存活率）的预测因素。
酒精间隔消融术用于治疗药物难治性、伴严重流出道梗阻的肥厚型梗阻性心肌病患者。现有文献仅限于单中心结果，消融后临床结果的预测因素尚未确定。登记研究结果可提供重要数据。
共纳入 874 例行酒精间隔消融术的肥厚型梗阻性心肌病患者。大多数（64%）患者静息时存在严重梗阻，其余患者存在可诱发的梗阻。消融前，患者有严重呼吸困难（纽约心脏协会[NYHA]功能分级 III 或 IV：78%）和/或严重心绞痛（加拿大心血管学会心绞痛分级 III 或 IV：43%）。
消融后（NYHA 功能分级 III 和 IV 中约 5%，加拿大心血管学会心绞痛分级 III 中 8 例）有显著改善（p<0.01）。共有 81 例死亡，1、5 和 9 年的生存率估计值分别为 97%、86%和 74%。8 例患者出现前降支夹层，133 例患者出现心律失常。基线时射血分数较低、注入乙醇的间隔动脉数量较少、每位患者消融术数量较多、消融术后间隔厚度较大以及消融术后使用β受体阻滞剂与死亡率相关。
预测消融后死亡率的变量包括基线射血分数和 NYHA 功能分级、注入乙醇的间隔动脉数量、消融术后间隔厚度、β受体阻滞剂使用情况和消融术数量。
