Alyaydin Emyal, Vogel Julia Kirsten, Luedike Peter, Rassaf Tienush, Jánosi Rolf Alexander, Papathanasiou Maria
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelanstrasse 55, 45147 Essen, Germany.
J Clin Med. 2023 Apr 21;12(8):3024. doi: 10.3390/jcm12083024.
(1) Background: The transcoronary ablation of septal hypertrophy (TASH) is an established therapy for hypertrophic obstructive cardiomyopathy (HOCM). Previous studies on this topic are characterised by a consistent male predominance and show a worse prognosis in females. (2) Methods: This study is a retrospective analysis of all TASH procedures conducted between 2006 and 2021 at a tertiary academic centre. A solution of 75 µm microspheres (Embozene, Boston Scientific, Marlborough, MA, USA) was used as an embolising agent. The outcomes of interest were left ventricular outflow tract (LVOT) gradient reduction and symptom improvement among males vs. that among females. Secondarily, we analysed the sex-related differences in procedural safety outcomes and mortality. (3) Results: The study population consisted of 76 patients, with a median age of 61 years. Females comprised 57% of the cohort. We observed no sex-related differences in the baseline LVOT gradients at rest or under provocation ( = 0.560 and = 0.208, respectively). Females were significantly older at the time of the procedure ( < 0.001), had lower tricuspid annular systolic excursion (TAPSE) ( = 0.009), presented a worse clinical status according to the NYHA functional classification (for NYHA ≥ 3, < 0.001), and were more often on diuretics ( < 0.001). We did not observe sex-related differences in absolute gradient reduction at rest ( = 0.147) and under provocation ( = 0.709). There was a reduction in the NYHA class by a median value of 1 ( = 0.636) at follow-up for both sexes. Postprocedural access site complications were documented in four cases (two of which concerned females), and complete atrioventricular block was noted in five patients (three of which concerned females). The 10-year survival rates were comparable between the sexes (85% in females and 88% in males). The female sex was not associated with enhanced mortality according to multivariate analysis after adjusting for the confounding variables (HR 0.94; 95% CI 0.376-2.350; = 0.895), but we observed age-related differences in long-term mortality (HR 1.035; 95% CI 1.007-1.063; = 0.015). (4) Conclusions: TASH is safe and effective in both sexes, irrespective of their clinical differences. Women present at an advanced age and with more severe symptoms. An advanced age at the time of the intervention is an independent predictor of mortality.
（1）背景：经冠状动脉间隔肥厚消融术（TASH）是肥厚性梗阻性心肌病（HOCM）的一种既定治疗方法。此前关于该主题的研究的特点是男性占主导地位，且女性预后较差。（2）方法：本研究是对2006年至2021年在一家三级学术中心进行的所有TASH手术的回顾性分析。使用75微米微球溶液（Embozene，美国波士顿科学公司，马尔伯勒，马萨诸塞州）作为栓塞剂。关注的结果是男性与女性左心室流出道（LVOT）梯度降低情况和症状改善情况。其次，我们分析了手术安全性结果和死亡率方面的性别差异。（3）结果：研究人群包括76例患者，中位年龄为61岁。女性占队列的57%。我们观察到静息或激发状态下的基线LVOT梯度在性别上无差异（分别为P = 0.560和P = 0.208）。女性手术时年龄显著更大（P < 0.001），三尖瓣环收缩期位移（TAPSE）更低（P = 0.009），根据纽约心脏协会（NYHA）功能分级临床状态更差（NYHA≥3级时，P < 0.001），且更常使用利尿剂（P < 0.001）。我们未观察到静息（P = 0.147）和激发状态下（P = 0.709）绝对梯度降低在性别上的差异。随访时两性NYHA分级中位数均降低1级（P = 0.636）。术后有4例记录了穿刺部位并发症（其中2例涉及女性），5例患者出现完全性房室传导阻滞（其中3例涉及女性）。两性10年生存率相当（女性为85%，男性为88%）。校正混杂变量后，多因素分析显示女性性别与死亡率增加无关（风险比0.94；95%置信区间0.376 - 2.350；P = 0.895），但我们观察到长期死亡率存在年龄相关差异（风险比1.035；95%置信区间1.007 - 1.063；P = 0.015）。（4）结论：TASH对两性均安全有效，无论其临床差异如何。女性就诊时年龄更大且症状更严重。干预时年龄较大是死亡率的独立预测因素。
