Li P J, Sun J J, Chen M L, Yu X P, Zhao H, Gao Y C, Zhang X L, Jiang T Y, He J Q
Department of Cardiology, Anzhen Hospital Affiliated to Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2022 Apr 24;50(4):369-374. doi: 10.3760/cma.j.cn112148-20220303-00142.
To observe the therapeutic effects of alcohol septal ablation (ASA) in mildly symptomatic patients (NYHA class Ⅱ) with hypertrophic obstructive cardiomyopathy(HOCM). This retrospective study included 150 mildly symptomatic patients with HOCM hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University from March 2001 to December 2017, consisting of medical therapy group (=102) and ASA group (=48). Baseline clinical data were collected, patients were followed up to a mean of 6.0 (3.5, 8.1) years. Overall and HCM-related mortality events (including chronic heart failure, atrial fibrillation related stroke, sudden cardiac death) were observed in the two groups. Moreover, the improvement of NYHA function classification and left ventricular outflow tract gradient (LVOTG) were also evaluated. Survival analysis was performed by Kaplan-Meier method. Age of this cohort was (52.9±14.5)years, 92 cases(61.3%) were male. In the follow-up, LVOTG was reduced from (85.8±35.4)mmHg (1 mmHg=0.133 kPa) to (27.7±19.8)mmHg (<0.001) in the ASA group, and from (66.3±35.0)mmHg to (56.5±27.7)mmHg in medical therapy group(<0.01). At the last clinical follow-up, there were 32 patients (66.7%) whose LVOTG were<30 mmHg, septal thickness decreased from (20.3±3.8)mm to (16.1±3.4)mm (<0.001), NYHA classification was also remarkably improved (<0.001). New-onset atrial fibrillation tended to be lower in the ASA group compared to medical therapy group (9.3%(4/43) vs. 20.8%(20/96),=0.096). Eleven patients (10.8%) in the medical therapy group and 2 patients (4.2%) in the ASA group died during the follow-up. One patient received pacemaker during the peri-procedural period, 1 patient was implanted with two-chamber pacemaker due to Ⅲ° atrioventricular block at 10 years after operation in the ASA group. Survival free of all-cause mortality of ASA group at 5 and 10 years was 97.9% and 97.9%, respectively, which was comparable to the medical therapy group (=0.231). Survival free of HCM-related mortality was similar between the two groups (=0.397). Compared with medical therapy in mildly symptomatic patients with HOCM, long-term survival rate is similar after ASA. Meanwhile, ASA can remarkably reduce LVOTG and improve the clinical status of the patients. Therefore, ASA may be used as an alternative therapy for mildly symptomatic HOCM patients.
观察酒精室间隔消融术（ASA）对症状较轻（纽约心脏协会心功能Ⅱ级）的肥厚性梗阻性心肌病（HOCM）患者的治疗效果。这项回顾性研究纳入了2001年3月至2017年12月在北京首都医科大学附属北京安贞医院住院的150例症状较轻的HOCM患者，分为药物治疗组（n = 102）和ASA组（n = 48）。收集基线临床数据，患者平均随访6.0（3.5，8.1）年。观察两组的全因死亡率和HCM相关死亡事件（包括慢性心力衰竭、房颤相关卒中、心源性猝死）。此外，还评估了纽约心脏协会心功能分级和左心室流出道压差（LVOTG）的改善情况。采用Kaplan-Meier法进行生存分析。该队列患者年龄为（52.9±14.5）岁，男性92例（61.3%）。随访期间，ASA组LVOTG从（85.8±35.4）mmHg（1 mmHg = 0.133 kPa）降至（27.7±19.8）mmHg（P < 0.001），药物治疗组从（66.3±35.0）mmHg降至（56.5±27.7）mmHg（P < 0.01）。在最后一次临床随访时，32例患者（66.7%）的LVOTG < 30 mmHg，室间隔厚度从（20.3±3.8）mm降至（16.1±3.4）mm（P < 0.001），纽约心脏协会心功能分级也显著改善（P < 0.001）。与药物治疗组相比，ASA组新发房颤的发生率较低（9.3%（4/43）对20.8%（20/96），P = 0.096）。随访期间，药物治疗组11例患者（10.8%）死亡，ASA组2例患者（4.2%）死亡。ASA组1例患者在围手术期接受了起搏器植入，1例患者在术后10年因Ⅲ度房室传导阻滞植入了双腔起搏器。ASA组5年和10年的全因死亡率生存率分别为97.9%和97.9%，与药物治疗组相当（P = 0.231）。两组HCM相关死亡率生存率相似（P = 0.397）。与药物治疗相比，ASA治疗症状较轻的HOCM患者长期生存率相似。同时，ASA可显著降低LVOTG，改善患者临床状况。因此，ASA可作为症状较轻的HOCM患者的替代治疗方法。
