Department of Cardiology, Second Medical School, Charles University, Motol University Hospital, Prague, Czech Republic.
Department of Cardiology, St.Antonius Hospital, Nieuwegein, the Netherlands.
Int J Cardiol. 2020 Nov 15;319:101-105. doi: 10.1016/j.ijcard.2020.06.049. Epub 2020 Jul 17.
According to European guidelines, alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) may be less effective in patients with extensive septal scarring on cardiac magnetic resonance (CMR). This study aimed to analyze the impact of late gadolinium enhancement (LGE) on CMR on the effectiveness of ASA.
We conducted an observational retrospective study involving adult patients with symptomatic drug-refractory HOCM who underwent CMR before ASA at two European centres from May 2010 through June 2019. Patients were compared in binary format based on LGE presence. Moreover, a subanalysis focused on patients with septal fibrosis was performed. The effectiveness of ASA was evaluated by echocardiographic, ECG and clinical findings.
Of the 113 study patients, 54 (48%) had LGE on CMR. The LGE quantification performed in 29 patients revealed septal fibrosis in 17. The mean follow-up was 4.4 ± 2.6 years. Baseline parameters were similar between groups except for basal septal thickness that was greater in LGE+ group (21.1 ± 3.9 mm for LGE+ vs. 19.2 ± 3.2 mm for LGE-: p = .005). ASA improved symptoms in all groups and reduced left ventricular outflow tract obstruction (LVOTO) (delta gradient reduction: LGE+: 62 ± 37.3%; septal LGE+: 75.6 ± 20.8%; LGE-: 72.5 ± 21.0%). However, 13% of the LGE+ and 2% of the LGE- group had residual LVOTO above 30 mmHg (p = .027).
ASA was effective in all patients with HOCM, whether they had LGE on CMR or not and whether they had septal fibrosis or not.
根据欧洲指南，对于肥厚型梗阻性心肌病（HOCM）患者，酒精室间隔消融术（ASA）的效果可能较差，因为在心脏磁共振（CMR）上存在广泛的室间隔瘢痕。本研究旨在分析 CMR 上晚期钆增强（LGE）对 ASA 效果的影响。
我们进行了一项观察性回顾性研究，纳入了 2010 年 5 月至 2019 年 6 月在欧洲的两个中心接受 ASA 治疗的有症状药物难治性 HOCM 成年患者。患者根据 LGE 的存在以二进制格式进行比较。此外，还进行了一项亚分析，重点关注有间隔纤维化的患者。ASA 的效果通过超声心动图、心电图和临床发现进行评估。
在 113 例研究患者中，54 例（48%）CMR 上有 LGE。在 29 例患者中进行的 LGE 定量分析显示，17 例有间隔纤维化。平均随访时间为 4.4±2.6 年。两组之间的基线参数相似，除了 LGE+组的基底间隔厚度更大（21.1±3.9mm 与 LGE-组的 19.2±3.2mm：p=0.005）。ASA 改善了所有组的症状并降低了左心室流出道梗阻（LVOTO）（梯度降低量：LGE+组：62±37.3%；间隔 LGE+组：75.6±20.8%；LGE-组：72.5±21.0%）。然而，LGE+组有 13%和 LGE-组有 2%的患者残留 LVOTO 超过 30mmHg（p=0.027）。
ASA 对所有 HOCM 患者均有效，无论 CMR 上是否有 LGE，是否有间隔纤维化。
