Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey.
Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Catheter Cardiovasc Interv. 2018 Sep 1;92(3):557-565. doi: 10.1002/ccd.27442. Epub 2017 Dec 5.
Percutaneous septal reduction therapy by either alcohol or nonalcohol agents is an alternative approach to surgery in drug-refractory symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Nonalcohol agents have some advantages and disadvantages over alcohol during the procedure. Nowadays, a novel non-alcohol agent, named as Ethylene-vinyl alcohol (EVOH) copolymer (Onyx and Squid ), is used during septal ablation. Thus, in this study, we aimed to evaluate both acute and long-term efficacy and safety profile of EVOH during septal ablation in HOCM.
A total of 25 patients (52% female; mean age: 55.8 ± 17.1 years) with symptomatic HOCM were enrolled in the study. All subjects underwent clinical and laboratory assessment before and after the procedure. Peak left ventricular outflow tract (LVOT) gradient was significantly reduced just after the procedure (68 vs. 20 mmHg; P < 0.001). Peak serum creatine kinase-myocardial band and troponin I levels were 112 (35-282) ng/ml and 11 (4-93) ng/ml. EVOH embolization to diagonal artery was observed in 1 patient (4%) and the complete atrioventricular block was noted in 2 (8%) patients. During the 12-month follow-up, there was no mortality. There was a significant improvement in New York Heart Association functional class of the subjects P < 0.001). Both interventricular septum thickness and LVOT gradient showed a significant reduction during follow-up (P < 0.05). However, there was no reduction in the LVOT gradient of 3 patients (12%).
In conclusion, our small-sized preliminary study results showed that septal reduction therapy using EVOH is an effective alternative option in reducing symptoms and LVOT gradient in HOCM.
经皮间隔缩减治疗，无论是应用酒精或非酒精制剂，都是药物难治性肥厚型梗阻性心肌病（HOCM）患者的一种替代手术方法。在手术过程中，非酒精制剂相较于酒精制剂具有一些优点和缺点。目前，一种新型非酒精制剂，名为乙烯-乙烯醇（EVOH）共聚物（Onyx 和 Squid），用于间隔消融术。因此，在这项研究中，我们旨在评估 EVOH 在 HOCM 间隔消融术中的急性和长期疗效及安全性。
共纳入 25 名（52%为女性；平均年龄：55.8±17.1 岁）有症状的 HOCM 患者。所有患者均在术前和术后进行临床和实验室评估。术后即刻，左心室流出道（LVOT）峰值梯度明显降低（68 对 20mmHg；P<0.001）。肌酸激酶同工酶-心肌带和肌钙蛋白 I 的峰值血清水平分别为 112（35-282）ng/ml 和 11（4-93）ng/ml。1 例（4%）患者发生对角支 EVOH 栓塞，2 例（8%）患者发生完全性房室传导阻滞。在 12 个月的随访中，无死亡病例。患者纽约心脏协会心功能分级显著改善（P<0.001）。在随访过程中，室间隔厚度和 LVOT 梯度均显著降低（P<0.05）。然而，有 3 名患者（12%）的 LVOT 梯度无降低。
总之，我们的小型初步研究结果表明，EVOH 间隔缩减治疗是一种有效替代方案，可以减轻 HOCM 患者的症状和 LVOT 梯度。
