Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Catheter Cardiovasc Interv. 2013 Jan 1;81(1):E58-67. doi: 10.1002/ccd.24328. Epub 2012 Apr 17.
Alcohol septal ablation has emerged as a therapy for patients with obstructive hypertrophic cardiomyopathy (HCM). However, there are limited data on the predictors of success with the procedure.
We examined patient characteristics and cardiac morphology as well as procedural data on 166 HCM patients (mean age, 63 years; 43% men), who underwent ablation at Mayo Clinic. Patients were contacted to determine vital status and symptoms to assess the primary endpoint of survival free of death and severe symptoms (New York Heart Association, class III or IV dyspnea).
The strongest patient characteristics that predicted clinical success were older age, less severe left ventricular outflow tract gradient, lesser ventricular septal hypertrophy, and a smaller left anterior descending (LAD) diameter. Mitral valve geometry or ventricular septal morphology did not predict outcome. Patients with ≥3 characteristics (age ≥65 years, gradient <100 mmHg, septal hypertrophy ≤18 mm, LAD diameter <4.0 mm) had superior 4-year survival free of death and severe symptoms (90.4%) in comparison to those with two characteristics (81.6%) and ≤1 characteristic (57.5%). Case volume with >50 patients was an independent predictor of survival free of severe symptoms. The volume of alcohol injected, number of arteries injected, or size of septal perforator artery were not predictive of clinical success.
Greater case volume and selection for key patient and anatomic characteristics are associated with superior outcomes with alcohol septal ablation.
酒精室间隔消融术已成为治疗梗阻性肥厚型心肌病（HCM）患者的一种疗法。然而，关于该手术成功的预测因素的数据有限。
我们研究了 166 例在梅奥诊所接受消融术的 HCM 患者（平均年龄 63 岁；43%为男性）的患者特征和心脏形态以及手术数据。联系患者以确定其生存状态和症状，以评估无死亡和严重症状（纽约心脏协会，III 级或 IV 级呼吸困难）的主要终点。
预测临床成功的最强患者特征是年龄较大、左心室流出道梯度较轻、室间隔肥厚较小以及左前降支（LAD）直径较小。二尖瓣几何形状或室间隔形态不能预测结果。具有≥3 个特征（年龄≥65 岁、梯度<100mmHg、室间隔肥厚≤18mm、LAD 直径<4.0mm）的患者在 4 年无死亡和严重症状方面的存活率（90.4%）明显优于具有 2 个特征（81.6%）和≤1 个特征（57.5%）的患者。>50 例患者的手术量是无严重症状存活率的独立预测因素。注射酒精的量、注射动脉的数量或间隔穿孔动脉的大小与酒精室间隔消融术的临床成功无关。
更大的手术量和关键患者及解剖特征的选择与酒精室间隔消融术的良好预后相关。
