Veselka Josef, Faber Lothar, Liebregts Max, Cooper Robert, Januska Jaroslav, Krejci Jan, Bartel Thomas, Dabrowski Maciej, Hansen Peter Riis, Almaas Vibeke Marie, Seggewiss Hubert, Horstkotte Dieter, Adlova Radka, Bundgaard Henning, Ten Berg Jurriën, Stables Rodney Hilton, Jensen Morten Kvistholm
Department of Cardiology, 2nd Medical School, Charles University University Hospital Motol, Prague, Czech Republic
Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oyenhausen, Germany.
J Am Heart Assoc. 2017 May 16;6(5):e005735. doi: 10.1161/JAHA.117.005735.
The long-term efficacy and safety of alcohol septal ablation (ASA) in patients with highly symptomatic hypertrophic obstructive cardiomyopathy has been demonstrated. The aim of this study was to evaluate the long-term outcomes of mildly symptomatic patients with hypertrophic obstructive cardiomyopathy treated with ASA.
We retrospectively evaluated consecutive patients enrolled in the Euro-ASA registry (1427 patients) and identified 161 patients (53±13 years; 27% women) who were mildly symptomatic (New York Heart Association [NYHA] class II) pre-ASA. The median (interquartile range) follow-up was 4.8 (1.7-8.5) years. The clinical outcome was assessed and compared with the age- and sex-matched general population. The 30-day mortality after ASA was 0.6% and the annual all-cause mortality rate was 1.7%, which was similar to the age- and sex-matched general population (=0.62). A total of 141 (88%) patients had resting left ventricular outflow tract gradient at the last clinical checkup ≤30 mm Hg. Obstruction was reduced from 63±32 to 15±19 mm Hg (<0.01), and the mean NYHA class decreased from 2.0±0 to 1.3±0.1 (<0.01); 69%, 29%, and 2% of patients were in NYHA class I, II, and III at the last clinical checkup, respectively.
Mildly symptomatic hypertrophic obstructive cardiomyopathy patients treated with ASA had sustained symptomatic and hemodynamic relief with a low risk of developing severe heart failure. Their survival is comparable to the general population.
酒精间隔消融术（ASA）治疗症状严重的肥厚性梗阻性心肌病患者的长期疗效和安全性已得到证实。本研究旨在评估ASA治疗症状轻微的肥厚性梗阻性心肌病患者的长期疗效。
我们回顾性评估了纳入欧洲ASA注册研究的连续患者（1427例），并确定了161例ASA术前症状轻微（纽约心脏协会[NYHA]II级）的患者（年龄53±13岁；女性占27%）。中位（四分位间距）随访时间为4.8（1.7 - 8.5）年。评估临床结局并与年龄和性别匹配的普通人群进行比较。ASA术后30天死亡率为0.6%，年全因死亡率为1.7%，与年龄和性别匹配的普通人群相似（P = 0.62）。在最后一次临床检查时，共有141例（88%）患者静息左心室流出道压差≤30 mmHg。梗阻压差从63±32 mmHg降至15±19 mmHg（P<0.01），平均NYHA分级从2.0±0降至1.3±0.1（P<0.01）；在最后一次临床检查时，分别有69%、29%和2%的患者处于NYHA I级、II级和III级。
接受ASA治疗的症状轻微的肥厚性梗阻性心肌病患者症状和血流动力学得到持续改善，发生严重心力衰竭的风险较低。他们的生存率与普通人群相当。
