Division of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
Cardiovasc Interv Ther. 2024 Oct;39(4):479-489. doi: 10.1007/s12928-024-01014-4. Epub 2024 May 28.
This retrospective cohort study aimed to assess whether basal septal wall thickness (BSWT), anterior (AML) and posterior (PML) mitral leaflet length, or sex were associated with remaining left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA). One hundred fifty-four patients who underwent ASA at the Karolinska University Hospital in Stockholm, Sweden, between 2009 and 2021, were included retrospectively. Anatomical and hemodynamic parameters were collected from invasive catheterization before and during ASA, and from echocardiography (ECHO) examinations before, during, and at 1-year follow-up after ASA. Linear and logistic regression models were used to assess the association between sex, BSWT, AML, PML, and outcome, which was defined as the remaining LVOTO (≥ 30 mmHg) after ASA. The median follow-up was 364 days (interquartile range 334-385 days). BSWT ≥ 23 mm (n = 13, 12%) was associated with remaining LVOTO at follow-up (p = 0.004). Elongated mitral valve leaflet length (either AML or PML) was present in 125 (90%) patients. Elongated AML (> 24 mm) was present in 67 (44%) patients, although AML length was not associated with remaining LVOTO at follow-up. Elongated PML (> 14 mm) was present in 114 (74%) patients and was not associated with remaining LVOTO at follow-up. No significant sex differences were observed regarding the remaining LVOTO. ECHO measurement of BSWT can be effectively used to select patients for successful ASA and identify those patients with a risk of incomplete resolution of LVOTO after ASA.
这项回顾性队列研究旨在评估肥厚型梗阻性心肌病（HOCM）患者行酒精室间隔消融术（ASA）后，基底间隔壁厚度（BSWT）、前（AML）和后（PML）二尖瓣叶长度或性别是否与残留左心室流出道梗阻（LVOTO）相关。研究共纳入了 2009 年至 2021 年期间在瑞典斯德哥尔摩卡罗林斯卡大学医院接受 ASA 的 154 例患者。收集了患者行 ASA 前和术中的有创导管检查、ASA 前、ASA 中和 ASA 后 1 年的超声心动图（ECHO）检查的解剖和血流动力学参数。线性和逻辑回归模型用于评估性别、BSWT、AML、PML 与结局之间的关系，结局定义为 ASA 后残留的 LVOTO（≥30mmHg）。中位随访时间为 364 天（四分位间距 334-385 天）。BSWT≥23mm（n=13，12%）与随访时的残留 LVOTO 相关（p=0.004）。125 例（90%）患者存在二尖瓣叶过长。67 例（44%）患者 AML 过长（>24mm），但 AML 长度与随访时的残留 LVOTO 无关。114 例（74%）患者 PML 过长（>14mm），与随访时的残留 LVOTO 无关。在残留 LVOTO 方面，性别无显著差异。ECHO 测量 BSWT 可有效用于选择 ASA 成功的患者，并识别出 ASA 后 LVOTO 不完全缓解的风险患者。
