Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Can J Cardiol. 2023 Nov;39(11):1622-1629. doi: 10.1016/j.cjca.2023.06.417. Epub 2023 Jun 22.
The current ACC/AHA guidelines on hypertrophic cardiomyopathy (HCM) caution that alcohol septal ablation (ASA) might be less effective in patients with left ventricular outflow tract obstruction (LVOTO) ≥ 100 mm Hg.
We used a multinational registry to evaluate the outcome of ASA patients according to baseline LVOTO.
A total of 1346 ASA patients were enrolled and followed for 5.8 ± 4.7 years (7764 patient-years). The patients with baseline LVOTO ≥ 100 mm Hg were significantly older (61 ± 14 years vs 57 ± 13 years; P < 0.01), more often women (60% vs 45%; P < 0.01), and had a more pronounced HCM phenotype than those with baseline LVOTO < 100 mm Hg. There were no significant differences in the occurrences of 30-day major cardiovascular adverse events in the 2 groups. After propensity score matching (2 groups, 257 pairs of patients), the long-term survival was similar in both groups (P = 0.10), the relative reduction of LVOTO was higher in the group with baseline LVOTO ≥ 100 mm Hg (82 ± 21% vs 73 ± 26%; P < 0.01), but the residual resting LVOTO remained higher in this group (23 ± 29 mm Hg vs 13 ± 13 mm Hg; P < 0.01). Dyspnoea (NYHA functional class) at the most recent clinical check-up was similar in the 2 groups (1.7 ± 0.7 vs 1.7 ± 0.7; P = 0.85), and patients with baseline LVOTO ≥ 100 mm Hg underwent more reinterventions (P = 0.02).
After propensity matching, ASA patients with baseline LVOTO ≥ 100 mm Hg had similar survival and dyspnoea as patients with baseline LVOTO < 100 mm Hg, but their residual LVOTO and risk of repeated procedures were higher.
目前，美国心脏病学会/美国心脏协会（ACC/AHA）关于肥厚型心肌病（HCM）的指南警告称，对于左心室流出道梗阻（LVOTO）≥100mmHg 的患者，酒精室间隔消融（ASA）可能效果较差。
我们使用一个多国家注册中心，根据基线 LVOTO 评估 ASA 患者的结局。
共纳入 1346 例 ASA 患者，平均随访 5.8±4.7 年（7764 患者年）。基线 LVOTO≥100mmHg 的患者年龄明显更大（61±14 岁 vs 57±13 岁；P<0.01），女性更多（60% vs 45%；P<0.01），HCM 表型较基线 LVOTO<100mmHg 的患者更明显。两组患者 30 天主要心血管不良事件的发生率无显著差异。经倾向性评分匹配（每组 257 对患者）后，两组患者的长期生存率相似（P=0.10），基线 LVOTO≥100mmHg 的患者 LVOTO 降低更显著（82±21% vs 73±26%；P<0.01），但该组患者的残余静息 LVOTO 仍较高（23±29mmHg vs 13±13mmHg；P<0.01）。两组患者最近一次临床检查时的呼吸困难（NYHA 心功能分级）相似（1.7±0.7 vs 1.7±0.7；P=0.85），但基线 LVOTO≥100mmHg 的患者行再介入治疗的次数更多（P=0.02）。
经倾向性评分匹配后，基线 LVOTO≥100mmHg 的 ASA 患者的生存率和呼吸困难与基线 LVOTO<100mmHg 的患者相似，但残余 LVOTO 和再次介入治疗的风险更高。
