Veselka Josef, Tomasov Pavol, Zemánek David
Department of Cardiology, 2nd Medical School, Charles University and University Hospital Motol, Czech Republic.
J Invasive Cardiol. 2012 Dec;24(12):636-40.
The aim of this study was to determine whether the differences in the baseline septal morphology influenced outcomes of patients after alcohol septal ablation (ASA).
A total of 100 consecutive, highly symptomatic patients with HOCM and a neutral or sigmoid septum (74 patients vs 26 patients) underwent ASA and were examined clinically and echocardiographically at baseline and at follow-up (median 30 months vs 24 months).
At baseline, a neutral septum morphology was associated with a thicker basal septum [21 (19-24) mm vs 19 (18-20) mm; P<0.01] and higher pressure gradient at rest [59 (39-80) mm vs 43 (33-50) mm; P<0.01], but a similar pressure gradient after provocation [100 (72-120) mmHg vs 97 (70-110) mmHg; P=0.31], and subsequently both resting gradient [10 (10-16) mmHg vs 12 (10-15) mmHg; P=0.67] and provoked gradient after ASA [20 (10- 30) mmHg vs 18 (12-25) mmHg; P=0.71]. Four patients died during follow-up (4% vs 4%; NS). Pressure gradient, septum thickness and symptoms decreased significantly in both groups.
Patients treated with ASA who had a sigmoid septum were characterized at baseline by a thinner basal septum and lower pressure gradient at rest. However, they showed an identical pressure gradient after provocation and subsequently after ASA. ASA was safe and effective in both groups of patients.
本研究旨在确定基线时室间隔形态的差异是否会影响酒精室间隔消融术（ASA）后患者的预后。
共有100例连续的、症状严重的肥厚型梗阻性心肌病（HOCM）患者，其室间隔形态为中立型或乙状型（74例对26例），接受了ASA治疗，并在基线和随访时（中位时间分别为30个月和24个月）进行了临床和超声心动图检查。
基线时，中立型室间隔形态与较厚的基底室间隔相关[21（19 - 24）mm对19（18 - 20）mm；P<0.01]以及静息时较高的压力阶差[59（39 - 80）mm对43（33 - 50）mm；P<0.01]，但激发后压力阶差相似[100（72 - 120）mmHg对97（70 - 110）mmHg；P = 0.31]，随后ASA后静息阶差[10（10 - 16）mmHg对12（10 - 15）mmHg；P = 0.67]和激发阶差[20（10 - 30）mmHg对18（12 - 25）mmHg；P = 0.71]。随访期间有4例患者死亡（4%对4%；无显著性差异）。两组患者的压力阶差、室间隔厚度和症状均显著降低。
接受ASA治疗且室间隔为乙状型的患者在基线时的特征是基底室间隔较薄且静息时压力阶差较低。然而，他们在激发后以及随后ASA后的压力阶差相同。ASA在两组患者中均安全有效。
