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Lawrenz T, Lawin D, Stellbrink C. Myosin Inhibitors for Hypertrophic Obstructive Cardiomyopathy (HOCM): Is HOCM Passing Another Crossroads? Can J Cardiol 2024; 40:820-823. [PMID: 38311167 DOI: 10.1016/j.cjca.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Thorsten Lawrenz
- Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Bielefeld, Germany.
| | - Dennis Lawin
- Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Bielefeld, Germany
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Bielefeld, Germany
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 339] [Impact Index Per Article: 339.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Al Samarraie A, Petzl A, Cadrin-Tourigny J, Tadros R. Sudden Death Risk Assessment in Hypertrophic Cardiomyopathy Across the Lifespan: Reconciling the American and European Approaches. Card Electrophysiol Clin 2023; 15:367-378. [PMID: 37558306 DOI: 10.1016/j.ccep.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited cardiac disease. Since the modern description of HCM more than seven decades ago, great focus has been placed on preventing its most catastrophic complication: sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICD) have been recognized to provide effective prophylactic therapy. Over the years, two leading societies, the European Society of Cardiology (ESC) and the American Heart Association/American College of Cardiology (AHA/ACC), have proposed risk stratification models to assess SCD in adults. European guidelines rely on a risk calculator, the HCM Risk-SCD, while American guidelines propose a stand-alone risk factor approach. Recently, risk prediction models were also developed in the pediatric population. This article reviews the latest recommendations on the risk stratification of SCD in HCM and summarises current indications for ICD use.
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Affiliation(s)
- Ahmad Al Samarraie
- Cardiovascular Genetics Centre, Montreal Heart Institute, 5000 Bélanger, Montreal, Quebec H1T 1C8, Canada; Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada
| | - Adrian Petzl
- Cardiovascular Genetics Centre, Montreal Heart Institute, 5000 Bélanger, Montreal, Quebec H1T 1C8, Canada; Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Centre, Montreal Heart Institute, 5000 Bélanger, Montreal, Quebec H1T 1C8, Canada; Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Centre, Montreal Heart Institute, 5000 Bélanger, Montreal, Quebec H1T 1C8, Canada; Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada.
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Yuzawa-Tsukada N, Tokuda M, Miyamoto T, Yoshimura M. Percutaneous transluminal septal myocardial ablation was effective in hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles: a case report. Eur Heart J Case Rep 2023; 7:ytac493. [PMID: 36694877 PMCID: PMC9856278 DOI: 10.1093/ehjcr/ytac493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
Background Abnormalities of the mitral subvalvular apparatus are not uncommon in hypertrophic obstructive cardiomyopathy (HOCM). Where invasive treatment is indicated in these patients to reduce left ventricular outflow tract (LVOT) obstruction, surgical myectomy with mitral valve repair is recommended. Case summary In this report, we describe the case of a patient with HOCM and anomalous papillary muscle anatomy, successfully treated by percutaneous transluminal septal myocardial ablation (PTSMA). Discussion PTSMA effectively reduced septal myocardial thickness and LVOT gradient, with only mild residual systolic anterior motion and mitral regurgitation despite anomalous papillary muscle anatomy. Upon careful anatomical evaluation, PTSMA may be a suitable therapeutic option for patients with LVOT obstruction and mitral valve abnormalities who are poor surgical candidates.
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Affiliation(s)
| | - Michifumi Tokuda
- Division of Cardiology, Department of Internal Medicine, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8506, Japan
| | - Takashi Miyamoto
- Division of Cardiology, Saitama Cardiovascular Respiratory Center, Kumagaya, Saitama, Japan
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Mavacamten, a novel revolutionizing therapy in hypertrophic obstructive cardiomyopathy: A literature review. Rev Port Cardiol 2022; 41:693-703. [DOI: 10.1016/j.repc.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
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Maekawa Y, Takamisawa I, Takano H, Takayama M. Percutaneous transluminal septal myocardial ablation: past, present, and future. J Cardiol 2021; 80:211-217. [PMID: 34924238 DOI: 10.1016/j.jjcc.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
About 30% of patients with hypertrophic cardiomyopathy have a significant left ventricular pressure gradient at rest, and 60%-70% of these patients are diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) because an induced pressure gradient is also present. Percutaneous transluminal septal myocardial ablation (PTSMA) is a procedure in which ethanol is used to ablate the portion of the septal myocardium that is involved in the pathogenesis of the left ventricular outflow tract pressure gradient (LVOT PG). In 1995, Sigwart et al. reported three cases of PTSMA in The Lancet. The introduction of PTSMA into clinical practice has enabled the reduction of LVOT PG and improvement of heart failure symptoms in elderly and high-risk patients with symptomatic, drug-refractory HOCM. In 1998, Faber et al. published a report in Circulation on selective septal myocardial ablation using myocardial contrast echocardiography (MCE). MCE-guided PTSMA is now recognized as the standard method of PTSMA in many countries and regions, including Europe, North America, and Asia, and is estimated to be performed on about 300 to 400 patients per year in Japan based on reports from the Japanese Circulation Society's Clinical Practice Survey. The current problems with this technique are: 1) the outcome is greatly influenced by operators' and institutional experience, and 2) it is difficult to determine in advance whether the patient is a PTSMA responder or not. Recently, advancements in imaging modalities, including cardiac computed tomography and magnetic resonance imaging, have facilitated clarification of the mechanisms of LVOT obstruction. Therefore, more appropriate decisions regarding PTSMA and surgical myectomy (SM) are now made. Better treatment selection will undoubtedly improve the prognosis of patients with drug-refractory HOCM complicated by heart failure, and further elucidation of the pathogenesis of LVOT obstruction and technical advances in PTSMA and SM are eagerly awaited.
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Affiliation(s)
- Yuichiro Maekawa
- Internal Medicine III, Division of Cardiology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hitoshi Takano
- Department of Cardiology, Nippon Medical School, Tokyo, Japan
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Arévalos V, Rodríguez-Arias JJ, Brugaletta S, Micari A, Costa F, Freixa X, Masotti M, Sabaté M, Regueiro A. Alcohol Septal Ablation: An Option on the Rise in Hypertrophic Obstructive Cardiomyopathy. J Clin Med 2021; 10:2276. [PMID: 34073940 PMCID: PMC8197319 DOI: 10.3390/jcm10112276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) can cause symptoms due to the obstruction of the left ventricle outflow tract (LVOT). Although pharmacological therapy is the first step for treating this condition, many patients do not fully respond to the treatment, and an invasive approach is required to manage symptoms. Septal reduction therapies include septal myectomy (SM) and alcohol septal ablation (ASA). ASA consists of a selective infusion of high-grade alcohol into a septal branch supplying the basal interventricular septum to create an iatrogenic infarction with the aim of reducing LVOT obstruction. Currently, SM and ASA have the same level of indication; however, ASA is normally reserved for patients of advanced age, with comorbidities or when the surgical approach is not feasible. Recent data suggests that there are no differences in short- and long-term all-cause mortality, cardiovascular mortality and sudden cardiac death between ASA and SM. Despite the greater experience and refinement of the technique gained in recent years, the most common complication continues to be complete atrio-ventricular block, requiring a permanent pacemaker. Septal reduction therapies should be performed in experienced centres with comprehensive programs.
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Affiliation(s)
- Victor Arévalos
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (V.A.); (J.J.R.-A.); (S.B.); (X.F.); (M.M.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Juan José Rodríguez-Arias
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (V.A.); (J.J.R.-A.); (S.B.); (X.F.); (M.M.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (V.A.); (J.J.R.-A.); (S.B.); (X.F.); (M.M.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Antonio Micari
- Interventional Cardiology Unit, Policlinic G. Martino, University of Messina, 98124 Messina, Italy; (A.M.); (F.C.)
| | - Francesco Costa
- Interventional Cardiology Unit, Policlinic G. Martino, University of Messina, 98124 Messina, Italy; (A.M.); (F.C.)
| | - Xavier Freixa
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (V.A.); (J.J.R.-A.); (S.B.); (X.F.); (M.M.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Mónica Masotti
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (V.A.); (J.J.R.-A.); (S.B.); (X.F.); (M.M.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Manel Sabaté
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (V.A.); (J.J.R.-A.); (S.B.); (X.F.); (M.M.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Ander Regueiro
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (V.A.); (J.J.R.-A.); (S.B.); (X.F.); (M.M.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
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Matsuda J, Takano H, Morooka M, Imori Y, Nakata J, Kitamura M, Tara S, Tokita Y, Yamamoto T, Takayama M, Shimizu W. Relationship Between Procedural Right Bundle Branch Block and 1-Year Outcome After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy - A Retrospective Study. Circ J 2021; 85:1481-1491. [PMID: 33896903 DOI: 10.1253/circj.cj-20-1191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Alcohol septal ablation (ASA) is a treatment option in patients with drug-refractory symptomatic hypertrophic obstructive cardiomyopathy (HOCM). In many patients, right bundle branch block (RBBB) develops during ASA because septal branches supply the right bundle branch. However, the clinical significance of procedural RBBB is uncertain.Methods and Results:We retrospectively reviewed 184 consecutive patients with HOCM who underwent ASA. We excluded 40 patients with pre-existing RBBB (n=10), prior pacemaker implantation (n=15), mid-ventricular obstruction type (n=10), and those lost to follow-up (n=5), leaving 144 patients for analysis. Patients were divided into 2 groups according to the development (n=95) or not (n=49) of procedural RBBB. ASA conferred significant decreases in the left ventricular pressure gradient (LVPG) in both the RBBB and no-RBBB group (from 74±48 to 27±27 mmHg [P<0.001] and from 75±45 to 31±33 mmHg [P<0.001], respectively). None of the RBBB patients developed further conduction system disturbances. The percentage reduction in LVPG at 1 year after the procedure was significantly greater in the RBBB than no-RBBB group (66±24% vs. 49±45%; P=0.035). Procedural RBBB was not associated with pacemaker implantation after ASA, but was associated with reduction in repeat ASA (odds ratio 0.34; 95% confidence interval 0.13-0.92; P=0.045). CONCLUSIONS Although RBBB frequently occurs during the ASA procedure, it does not adversely affect clinical outcomes.
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Affiliation(s)
- Junya Matsuda
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaki Morooka
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Mitsunobu Kitamura
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Shuhei Tara
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yukichi Tokita
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | | | - Wataru Shimizu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital.,Department of Cardiovascular Medicine, Nippon Medical School
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Lawin D, Lawrenz T, Radke K, Wolff A, Stellbrink C. Alcohol-induced right bundle branch block is associated with a benign outcome in HOCM after alcohol septum ablation (ASA). Clin Res Cardiol 2021; 111:175-185. [PMID: 33772362 DOI: 10.1007/s00392-021-01847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alcohol septum ablation (ASA) is a treatment option for hypertrophic obstructive cardiomyopathy (HOCM). We examined the impact of ASA-induced bundle branch block (BBB) on clinical and hemodynamic features. METHODS AND RESULTS We retrospectively analysed 98 HOCM patients with regard to ASA-induced BBB. Clinical examination was performed at baseline, early after ASA and at chronic follow-up (FU). ASA reduced left ventricular outflow tract gradient (LVOTG) during chronic FU (69.2 ± 41.6 pre vs. 31.8 ± 30.3 mmHg post ASA; p < 0.05) and interventricular septal diameter (21.7 ± 3.4 pre vs. 18.7 ± 5.0 mm post ASA; p < 0.05). ASA-induced early right BBB (RBBB) until discharge was observed in 44.9% and chronic RBBB at FU in 32.7%. Left BBB (LBBB) occurred in 13.3% early after ASA and in only 4.1% at chronic FU. Chronic RBBB was associated with more pronounced exercise-induced LVOTG reduction (102.1 ± 55.2 with vs. 73.6 ± 60.0 mmHg without; p < 0.05). 6-min-walk-test (6-MWT) and NYHA class were not affected by RBBB. LBBB had no influence on LVOTG, 6-MWT and symptoms. More ethanol was injected in patients with early RBBB (1.1 ± 0.4 vs. 0.8 ± 0.3 ml without; p < 0.05), who also showed higher mean CK release (827 ± 341 vs. 583 ± 279 U/l without; p < 0.05). Pacemaker implantation during FU was necessary in 11.5% of patients with early RBBB, 3.1% with chronic RBBB, 7.7% with early LBBB and 0% with chronic LBBB (p = n.s. for BBB vs. no BBB). CONCLUSION ASA-induced RBBB is associated with a higher volume of infused ethanol and higher maximum CK release. RBBB does not adversely affect the clinical outcome or need for pacemaker implantation but was associated with higher exercise-induced LVOTG reduction during chronic FU.
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Affiliation(s)
- Dennis Lawin
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld gemGmbH, Teutoburger Straße 50, 33604, Bielefeld, Germany
| | - Thorsten Lawrenz
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld gemGmbH, Teutoburger Straße 50, 33604, Bielefeld, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred Herrenhausen Straße 50, 58455, Witten, Germany
| | - Kristin Radke
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld gemGmbH, Teutoburger Straße 50, 33604, Bielefeld, Germany
| | - Andreas Wolff
- Cardiology, Forum Salinum, Salinenstraße 4, 32105, Bad Salzuflen, Germany
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld gemGmbH, Teutoburger Straße 50, 33604, Bielefeld, Germany.
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10
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Vermaete I, Dujardin K, Stammen F. Looking back on 15 years of ultrasound-guided alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Acta Cardiol 2020; 75:483-491. [PMID: 31204591 DOI: 10.1080/00015385.2019.1626550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Septal reduction remains an important target of current therapeutic modalities in hypertrophic obstructive cardiomyopathy (HOCM). Surgical septal myectomy has long been considered the gold standard in pharmacotherapy-refractory severely symptomatic patients with marked left ventricular outflow tract (LVOT) obstruction. In recent years, percutaneous alcohol septal ablation (ASA) has matured into the preferred strategy for patients with favourable anatomy and no other coexisting surgically amenable disease.Methods: We discuss 26 HOCM patients with persistent dyspnoea, angina or syncope despite optimal medical treatment. Baseline septal wall thickness was 20 ± 3 mm, with peak resting/provoked LVOT gradients of 53 ± 35/112 ± 40 mmHg. Guided by echocardiography, alcohol injection could be restricted to the first septal coronary artery in 85% of patients, provoking basal septal infarction with average troponin rise of 3.0 ng/ml.Results: Eighty-six per cent of patients experienced sustained clinical improvement, associated with a reduction of septal wall thickness to 15 ± 3 mm and resting LVOT gradient to 21 ± 15 mmHg. One of the two non-responders underwent additional septal myectomy 11 years after ASA. Notable adverse events during the follow-up of 7.2 ± 4.7 years included: persistent conduction disturbances (65%) necessitating early postprocedural permanent pacemaker implantation (15%); atrial fibrillation (32%); ventricular tachycardia (4%) and aortic stenosis (14%). Six patients died, of which only 1 cardiac death.Conclusions: Our case series underscores the efficacy of ASA at relieving LVOT obstruction and improving symptoms in properly selected HOCM patients, with acceptably low procedural and long term mortality and morbidity.
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Affiliation(s)
- I. Vermaete
- Department of Cardiology, UZ Leuven, Leuven, Belgium
| | - K. Dujardin
- Department of Cardiology, AZ Delta, Roeselare, Belgium
| | - F. Stammen
- Department of Cardiology, AZ Delta, Roeselare, Belgium
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11
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Killu AM, Guerrero M, Siontis KC, El Sabbagh A, Eleid MF, Alkhouli M, Rihal C, Asirvatham SJ. A novel technique—Prophylactic septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement (RADIO‐TMVR). J Cardiovasc Electrophysiol 2020; 31:3048-3055. [DOI: 10.1111/jce.14720] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Ammar M. Killu
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Konstantinos C. Siontis
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Samuel J. Asirvatham
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
- Department of Pediatric and Adolescent Medicine Mayo Clinic Hospital Rochester Minnesota USA
- Department of Biomedical Engineering Mayo Clinic Hospital Rochester Minnesota USA
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12
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Kimmelstiel C, Rowin EJ. Fixed, high‐volume alcohol dose for septal ablation: High risk with no benefit. Catheter Cardiovasc Interv 2020; 95:1219-1220. [DOI: 10.1002/ccd.28917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Carey Kimmelstiel
- Hypertrophic Cardiomyopathy InstituteTufts Medical Center Boston Massachusetts USA
- Cardiac Catheterization LaboratoryTufts Medical Center Boston Massachusetts USA
| | - Ethan J. Rowin
- Hypertrophic Cardiomyopathy InstituteTufts Medical Center Boston Massachusetts USA
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Rigopoulos AG, Sakellaropoulos S, Ali M, Mavrogeni S, Manginas A, Pauschinger M, Noutsias M. Transcatheter septal ablation in hypertrophic obstructive cardiomyopathy: a technical guide and review of published results. Heart Fail Rev 2019; 23:907-917. [PMID: 29736811 DOI: 10.1007/s10741-018-9706-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter alcohol septal ablation (ASA) treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) is based on the existence and degree of intraventricular obstruction. Patients with significant gradient and symptoms who do not respond to optimal medical therapy are eligible to gradient reduction through a surgical (septal myectomy) or a transcatheter (alcohol septal ablation) septal reduction. The latter encompasses occlusion of a septal branch perfusing the hypertrophied septum, which is involved in the generation of obstruction, by injecting ethanol into the supplying septal branch(es). ASA has been established as a highly effective and safe method and has outnumbered the surgical gold standard. Although the technique is straightforward, patient selection and some technical details may influence the efficacy and safety of the procedure. The technique is based on echocardiographic contrast guidance, which allows accurate target septal branch selection and optimisation of the result. Published long-term results from high-volume centres have confirmed the effectiveness of ASA and have shown excellent survival, which is comparable to that in the general population. Choice and performance of the surgical or interventional treatment should be implemented in highly specialised centres in terms of a heart-team approach, taking notice of anatomic characteristics as well as comorbidities. Involvement of all cases in international registries may reveal the individual merits and indications for the surgical and interventional treatment in HOCM.
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Affiliation(s)
- Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany.
| | - Stefanos Sakellaropoulos
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany
| | - Muhammad Ali
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, Palaeo Faliro, Athens, Greece
| | - Athanassios Manginas
- Interventional Cardiology and Cardiology Department, Mediterraneo Hospital, Ilias Street 8-12, 16675, Glyfada, Greece
| | - Matthias Pauschinger
- Department of Cardiology, Internal Medicine 8, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany
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Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy through non-left anterior descending septal perforators. Heart Vessels 2019; 35:647-654. [PMID: 31641886 DOI: 10.1007/s00380-019-01525-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
Percutaneous transluminal septal myocardial ablation (PTSMA) has become a significant treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) despite maximal medical therapy. The target septal arteries usually arise from the left anterior descending artery (LAD). However, when septal perforators do not originate from the LAD, non-LAD septal perforators should be included as candidate-target septal branches that feed the hypertrophic septal myocardium, causing left ventricular outflow tract (LVOT) obstruction. Data pertaining to the procedure remain limited. We aimed to investigate PTSMA through the non-LAD septal perforators in patients with HOCM. In this case series review, we evaluated the baseline characteristics, echocardiographic features, and angiographic features, as well as symptoms and pressure gradient before and after PTSMA through the non-LAD septal perforators. Among 202 consecutive patients who underwent PTSMA for HOCM with LVOT obstruction, 21 had non-LAD septal branches that fed the hypertrophic septal myocardium and received alcohol ablation. Non-LAD septal perforators could be used as an alternative route for PTSMA in patients who experienced ineffective ablation of the septal branch that arises from the LAD. This unique procedure may improve response rates and overall outcomes of patients with HOCM.
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15
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Kashtanov MG, Rzhannikova AD, Chernyshev SD, Kardapoltsev LV, Idov EM, Berdnikov SV, Kochmasheva VV. Outcomes of hypertrophic obstructive cardiomyopathy patients undergoing alcohol septal ablation with a standard 3 mL dose of ethanol: Focus on long‐term safety. Catheter Cardiovasc Interv 2019; 95:1212-1218. [DOI: 10.1002/ccd.28499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/10/2019] [Accepted: 09/05/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Maksim G. Kashtanov
- Department of Endovascular therapySverdlovsk Regional Hospital No.1 Yekaterinburg Russia
- Ural Federal University Yekaterinburg Russia
| | - Anastasiya D. Rzhannikova
- Department of Endovascular therapySverdlovsk Regional Hospital No.1 Yekaterinburg Russia
- Department of Cardiovascular surgeryUral State Medical University Yekaterinburg Russia
| | - Sergey D. Chernyshev
- Department of Endovascular therapySverdlovsk Regional Hospital No.1 Yekaterinburg Russia
| | - Lev V. Kardapoltsev
- Department of Endovascular therapySverdlovsk Regional Hospital No.1 Yekaterinburg Russia
| | - Eduard M. Idov
- Department of Endovascular therapySverdlovsk Regional Hospital No.1 Yekaterinburg Russia
- Department of Cardiovascular surgeryUral State Medical University Yekaterinburg Russia
| | - Sergey V. Berdnikov
- Department of Endovascular therapySverdlovsk Regional Hospital No.1 Yekaterinburg Russia
| | - Valentina V. Kochmasheva
- Department of Endovascular therapySverdlovsk Regional Hospital No.1 Yekaterinburg Russia
- Department of Cardiovascular surgeryUral State Medical University Yekaterinburg Russia
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Kimmelstiel C, Zisa DC, Kuttab JS, Wells S, Udelson JE, Wessler BS, Rastegar H, Kapur NK, Weintraub AR, Maron BJ, Maron MS, Rowin EJ. Guideline-Based Referral for Septal Reduction Therapy in Obstructive Hypertrophic Cardiomyopathy Is Associated With Excellent Clinical Outcomes. Circ Cardiovasc Interv 2019; 12:e007673. [PMID: 31296080 DOI: 10.1161/circinterventions.118.007673] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The outcome of medically refractory patients with obstructive hypertrophic cardiomyopathy treated according to the American College of Cardiology/American Heart Association consensus guideline recommendations is not known. The objectives of this study were to define the short- and long-term outcomes of medically refractory obstructive hypertrophic cardiomyopathy patients undergoing alcohol septal ablation (ASA) and surgical septal myectomy (SM) with patient management in accordance with these consensus guidelines, as well as to quantify procedural risk and burden of comorbid conditions at the time of treatment. METHODS AND RESULTS Patients with obstructive hypertrophic cardiomyopathy referred for either ASA or SM from 2004 to 2015 were followed for the primary end point of short- and long-term mortality and compared with respective age- and sex-matched US populations. Of 477 consecutive severely symptomatic patients, 99 underwent ASA and 378 SM. Compared with SM, ASA patients were older ( P<0.001), had a higher burden of comorbid conditions ( P<0.01), and significantly higher predicted surgical mortality ( P<0.005). Procedure-related mortality was 0.3% and similarly low in both groups (0% in ASA and 0.8% in SM). Over 4.0±2.9 years of follow-up, 95% of patients had substantial improvement in heart failure symptoms to New York Heart Association class I/II (96% in SM and 90% in ASA). Long-term mortality was similar between the 2 groups with no difference compared with age- and sex-matched US populations. CONCLUSIONS Guideline-based referral for ASA and SM leads to excellent outcomes with low procedural mortality, excellent long-term survival, and improvement in symptoms. These outcomes occur in ASA patients despite being an older cohort with significantly more comorbidities.
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Affiliation(s)
- Carey Kimmelstiel
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - David C Zisa
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Johny S Kuttab
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Sophie Wells
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - James E Udelson
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Benjamin S Wessler
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Hassan Rastegar
- Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Division of Cardiothoracic Surgery (H.R.), Tufts Medical Center, Boston, MA
| | - Navin K Kapur
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Andrew R Weintraub
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Barry J Maron
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Martin S Maron
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Ethan J Rowin
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
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17
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Jahnlová D, Tomašov P, Adlová R, Januška J, Krejčí J, Dabrowski M, Veselka J. Outcome of patients ≥ 60 years of age after alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Arch Med Sci 2019; 15:650-655. [PMID: 31110530 PMCID: PMC6524201 DOI: 10.5114/aoms.2019.84735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/29/2017] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The outcome of patients ≥ 60 years of age after alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) remains unresolved. We sought to determine the long-term survival and the causes of death in this population. MATERIAL AND METHODS We enrolled 156 consecutive patients (69 ±6 years, 69% women, follow-up: 4.8 ±3.5 years) who underwent ASA at ≥ 60 years of age. RESULTS The 30-day mortality rate was 1.3%. At the last check-up, 81% of patients were in New York Heart Association class ≤ 2 and 76% had a left ventricular outflow tract gradient (LVOG) ≤ 30 mm Hg. A total of 39 patients died (51% of cardiovascular causes, 44% of non-cardiovascular causes, 5% of unknown causes) during the 734 patient-years. The annual sudden mortality, the sudden mortality and the all-cause mortality rates were 0.5%, 1.1%, and 4.8%, respectively. The all-cause mortality was higher compared to the age- and sex-matched general population (p = 0.002). CONCLUSIONS Alcohol septal ablation was safe and effective in the long-term follow-up. We observed a reduced life expectancy compared to the age- and sex-matched general population. Mortality was almost equally due to cardiovascular and non-cardiovascular causes of death.
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Affiliation(s)
- Denisa Jahnlová
- Department of Cardiology, Charles University in Prague, 2 Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Pavol Tomašov
- Department of Cardiology, Charles University in Prague, 2 Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Radka Adlová
- Department of Cardiology, Charles University in Prague, 2 Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Jaroslav Januška
- Department of Cardiology, Heart Centre, Hospital Podlesí a. s., Třinec, Czech Republic
| | - Jan Krejčí
- St. Anne’s University Hospital, Brno, Czech Republic
| | | | - Josef Veselka
- Department of Cardiology, Charles University in Prague, 2 Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
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18
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Seferović PM, Polovina M, Bauersachs J, Arad M, Gal TB, Lund LH, Felix SB, Arbustini E, Caforio AL, Farmakis D, Filippatos GS, Gialafos E, Kanjuh V, Krljanac G, Limongelli G, Linhart A, Lyon AR, Maksimović R, Miličić D, Milinković I, Noutsias M, Oto A, Oto Ö, Pavlović SU, Piepoli MF, Ristić AD, Rosano GM, Seggewiss H, Ašanin M, Seferović JP, Ruschitzka F, Čelutkiene J, Jaarsma T, Mueller C, Moura B, Hill L, Volterrani M, Lopatin Y, Metra M, Backs J, Mullens W, Chioncel O, Boer RA, Anker S, Rapezzi C, Coats AJ, Tschöpe C. Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21:553-576. [DOI: 10.1002/ejhf.1461] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/20/2019] [Accepted: 02/28/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Petar M. Seferović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Marija Polovina
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Johann Bauersachs
- Department of Cardiology and AngiologyMedical School Hannover Hannover Germany
| | - Michael Arad
- Cardiomyopathy Clinic and Heart Failure Institute, Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Tuvia Ben Gal
- Department of CardiologyRabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Lars H. Lund
- Department of MedicineKarolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital Stockholm Sweden
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo Pavia Italy
| | - Alida L.P. Caforio
- Division of Cardiology, Department of Cardiological, Thoracic and Vascular SciencesUniversity of Padua Padua Italy
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Gerasimos S. Filippatos
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Elias Gialafos
- Second Department of CardiologyHeart Failure and Preventive Cardiology Section, Henry Dunant Hospital Athens Greece
| | | | - Gordana Krljanac
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe Limongelli
- Department of Cardiothoracic Sciences, Università della Campania ‘Luigi VanvitellI’Monaldi Hospital, AORN Colli, Centro di Ricerca Cardiovascolare, Ospedale Monaldi, AORN Colli, Naples, Italy, and UCL Institute of Cardiovascular Science London UK
| | - Aleš Linhart
- Second Department of Medicine, Department of Cardiovascular MedicineGeneral University Hospital, Charles University in Prague Prague Czech Republic
| | - Alexander R. Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital London UK
| | - Ružica Maksimović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Centre for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia Belgrade Serbia
| | - Davor Miličić
- Department of Cardiovascular DiseasesUniversity Hospital Center Zagreb, University of Zagreb Zagreb Croatia
| | - Ivan Milinković
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Michel Noutsias
- Mid‐German Heart Center, Department of Internal Medicine III, Division of CardiologyAngiology and Intensive Medical Care, University Hospital Halle, Martin‐Luther‐University Halle Halle Germany
| | - Ali Oto
- Department of CardiologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Öztekin Oto
- Department of Cardiovascular SurgeryDokuz Eylül University Faculty of Medicine İzmir Turkey
| | - Siniša U. Pavlović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Pacemaker Center, Clinical Center of Serbia Belgrade Serbia
| | | | - Arsen D. Ristić
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe M.C. Rosano
- Centre for Clinical and Basic Research, Department of Medical SciencesIRCCS San Raffaele Pisana Rome Italy
| | - Hubert Seggewiss
- Medizinische Klinik, Kardiologie & Internistische Intensivmedizin, Klinikum Würzburg‐Mitte Würzburg Germany
| | - Milika Ašanin
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Jelena P. Seferović
- Cardiovascular DivisionBrigham and Women's Hospital, Harvard Medical School Boston MA USA
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center Serbia and Faculty of MedicineUniversity of Belgrade Belgrade Serbia
| | - Frank Ruschitzka
- Department of CardiologyUniversity Heart Center Zürich Switzerland
| | - Jelena Čelutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of MedicineVilnius University Vilnius Lithuania
- State Research Institute Centre for Innovative Medicine Vilnius Lithuania
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health ScienceLinköping University Linköping Sweden
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel, University of Basel Basel Switzerland
| | - Brenda Moura
- Cardiology DepartmentCentro Hospitalar São João Porto Portugal
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast Belfast UK
| | | | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd Volgograd Russia
| | - Marco Metra
- Cardiology, Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, University of Brescia Brescia Italy
| | - Johannes Backs
- Department of Molecular Cardiology and EpigeneticsUniversity of Heidelberg Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim Heidelberg Germany
| | - Wilfried Mullens
- BIOMED ‐ Biomedical Research Institute, Faculty of Medicine and Life SciencesHasselt University Diepenbeek Belgium
- Department of CardiologyZiekenhuis Oost‐Limburg Genk Belgium
| | - Ovidiu Chioncel
- University of Medicine Carol Davila Bucharest Romania
- Emergency Institute for Cardiovascular Diseases, ‘Prof. C. C. Iliescu’ Bucharest Romania
| | - Rudolf A. Boer
- Department of CardiologyUniversity Medical Center Groningen, University of Groningen Groningen The Netherlands
| | - Stefan Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité Berlin Germany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT) Berlin Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Charité Berlin Germany
| | - Claudio Rapezzi
- Cardiology, Department of ExperimentalDiagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna Bologna Italy
| | - Andrew J.S. Coats
- Monash University, Australia, and University of Warwick Coventry UK
- Pharmacology, Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy, and St George's University of London London UK
| | - Carsten Tschöpe
- Berlin‐Brandenburg Center for Regenerative Therapies, Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) Berlin, Department of CardiologyCampus Virchow Klinikum, Charite ‐ Universitaetsmedizin Berlin Berlin Germany
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19
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Kashtanov M, Rzhannikova A, Chernyshev S, Kardapoltsev L, Idov E, Berdnikov S. Results of Ten-Year Follow-Up of Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy. Int J Angiol 2018; 27:202-207. [PMID: 30410291 DOI: 10.1055/s-0038-1675213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This study looks at 10-year follow-up outcomes of alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy. Between 2000 and 2008, 40 patients with obstructive hypertrophic cardiomyopathy (27 males, 13 females) underwent alcohol septal ablation. The median follow-up period was 123 (2-179) months. The mean age ran to 43.8 + 13.9 years. The initial dose of ethanol (3 mL) was chosen for ablation in all cases. The hospital mortality was 0%. Permanent pacemakers were implanted in 3 of 40 (7.5%) cases in the hospital period. The median clinical follow-up was 123 (2-179) months. Survival rates at 1, 5, 10, and 15 years after the procedure were as follows: 97.5% (95% confidence interval [CI], 95.1-99.9%), 92.5% (95% CI, 94.8-90.2%), 85.0% (95% CI, 82.9-87.1%), and 81.3% (95% CI, 79.3-83.3%), respectively. Seven patients died during follow-up. Sudden death was observed in two cases. Permanent pacemakers were implanted in 2 of 40 (5%) cases in the follow-up. The log-rank test revealed no statistically significant difference between the 15-year survival rate in our cohort and age- and sex-matched general Russian population ( p = 0.11113). Alcohol septal ablation provides long-term survival rates that look comparable with age- and sex-matched general population in the 15-year follow-up period.
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Affiliation(s)
| | - Anastasiya Rzhannikova
- Sverdlovsk Regional Hospital No.1, Ekaterinburg, Russia.,Ural State Medical University, Ekaterinburg, Russia
| | | | | | - Eduard Idov
- Sverdlovsk Regional Hospital No.1, Ekaterinburg, Russia.,Ural State Medical University, Ekaterinburg, Russia
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20
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Asil S, Kaya B, Canpolat U, Yorgun H, Şahiner L, Çöteli C, Arat A, Aytemir K. Septal reduction therapy using nonalcohol agent in hypertrophic obstructive cardiomyopathy: Single center experience. Catheter Cardiovasc Interv 2018; 92:557-565. [PMID: 29205803 DOI: 10.1002/ccd.27442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/06/2017] [Accepted: 11/12/2017] [Indexed: 11/09/2022]
Abstract
AIMS Percutaneous septal reduction therapy by either alcohol or nonalcohol agents is an alternative approach to surgery in drug-refractory symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Nonalcohol agents have some advantages and disadvantages over alcohol during the procedure. Nowadays, a novel non-alcohol agent, named as Ethylene-vinyl alcohol (EVOH) copolymer (Onyx® and Squid® ), is used during septal ablation. Thus, in this study, we aimed to evaluate both acute and long-term efficacy and safety profile of EVOH during septal ablation in HOCM. METHODS AND RESULTS A total of 25 patients (52% female; mean age: 55.8 ± 17.1 years) with symptomatic HOCM were enrolled in the study. All subjects underwent clinical and laboratory assessment before and after the procedure. Peak left ventricular outflow tract (LVOT) gradient was significantly reduced just after the procedure (68 vs. 20 mmHg; P < 0.001). Peak serum creatine kinase-myocardial band and troponin I levels were 112 (35-282) ng/ml and 11 (4-93) ng/ml. EVOH embolization to diagonal artery was observed in 1 patient (4%) and the complete atrioventricular block was noted in 2 (8%) patients. During the 12-month follow-up, there was no mortality. There was a significant improvement in New York Heart Association functional class of the subjects P < 0.001). Both interventricular septum thickness and LVOT gradient showed a significant reduction during follow-up (P < 0.05). However, there was no reduction in the LVOT gradient of 3 patients (12%). CONCLUSIONS In conclusion, our small-sized preliminary study results showed that septal reduction therapy using EVOH is an effective alternative option in reducing symptoms and LVOT gradient in HOCM.
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Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Barış Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Levent Şahiner
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cem Çöteli
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Anıl Arat
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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21
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Mestres CA, Bartel T, Sorgente A, Müller S, Gruner C, Dearani J, Quintana E. Hypertrophic obstructive cardiomyopathy: what, when, why, for whom? Eur J Cardiothorac Surg 2018; 53:700-707. [PMID: 29438530 DOI: 10.1093/ejcts/ezy020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/30/2017] [Indexed: 11/13/2022] Open
Abstract
Hypertrophic cardiomyopathy is the most common genetic cardiovascular disorder and is associated with symptoms of heart failure and increased risk of sudden cardiac death. The most common condition is obstruction of the left ventricular outflow tract. Surgical septal myectomy and alcohol septal ablation are the 2 accepted modes of septal reduction therapy and are indicated when there are advanced symptoms and a peak left ventricular outflow gradient ≥50 mmHg. Advantages of alcohol septal ablation are limited groin approach, reduction of obstruction of the left ventricular outflow tract and functional improvement, but there are higher chances for intracardiac device implantation and residual obstruction. Septal myectomy offers very low mortality, absolute and immediate resolution of obstruction of the left ventricular outflow tract and survival comparative to a matched general population with almost negligible residual obstruction. It is recommended that patients with obstructive hypertrophic cardiomyopathy should be treated at experienced centres.
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Affiliation(s)
- Carlos A Mestres
- Department of Cardiovascular Surgery, Herzzentrum University Hospital Zürich, Zürich, Switzerland.,Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Thomas Bartel
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Antonio Sorgente
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Silvana Müller
- Department of Internal Medicine, Cardiology, Tirol Kliniken, University of Innsbruck, Innsbruck, Austria
| | - Christiane Gruner
- Department of Cardiology, Herzzentrum University Hospital Zürich, Zürich, Switzerland
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
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22
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Jensen MK, Jacobsson L, Almaas V, van Buuren F, Hansen PR, Hansen TF, Aakhus S, Eriksson MJ, Bundgaard H, Faber L. Influence of Septal Thickness on the Clinical Outcome After Alcohol Septal Alation in Hypertrophic Cardiomyopathy. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003214. [PMID: 27217377 DOI: 10.1161/circinterventions.115.003214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 04/14/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND We assessed the influence of interventricular septal thickness (IVSd) on the clinical outcome and survival after alcohol septal ablation (ASA) in patient with hypertrophic cardiomyopathy. METHODS AND RESULTS We analyzed 531 patients with hypertrophic cardiomyopathy (age: 56±14 years, men 55%) treated with ASA. Survival status was obtained 7.9±4.0 years after ASA. Baseline IVSd was inversely associated with survival (hazard ratio [HR] for 1 mm increment, 1.13; confidence interval, 1.05-1.21; P<0.001) after adjustment for age, sex, body mass index, and ASA-performing center. Compared with patients with baseline IVSd <20 mm, patients with baseline IVSd ≥25 mm had reduced survival (HR, 5.0; CI, 2.1-12), whereas patients with baseline IVSd 20 to 24 mm had similar survival (HR, 1.4; CI, 0.7-2.8). Baseline IVSd was not correlated with New York Heart Association class, Canadian Cardiology Society class, or syncope. Clinical outcome was assessed 0.6±0.6 years after ASA. IVSd was not related to left ventricular outflow tract gradient reduction at rest (P=0.883) or during Valsalva maneuver (P=0.885). The proportion of patients in New York Heart Association class 3 to 4 was reduced from 86% to 10%; in Canadian Cardiology Society class 3 to 4 from 26% to 2%; and with syncope from 25% to 2%. There were no correlations between baseline IVSd and New York Heart Association class (P=0.067), Canadian Cardiology Society class (P=0.106), or syncope (P=0.426) after ASA. CONCLUSIONS ASA had equal effects on left ventricular outflow tract gradients and symptoms throughout the spectrum of septal hypertrophy. Severe septal hypertrophy before ASA remained a marker of reduced survival after ASA with a 5-fold increased risk of all-cause mortality in patients with baseline IVSd >25 mm compared with patients with baseline IVSd <20 mm.
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Affiliation(s)
- Morten K Jensen
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
| | - Linda Jacobsson
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Vibeke Almaas
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Frank van Buuren
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Peter R Hansen
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Thomas F Hansen
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Svend Aakhus
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Maria J Eriksson
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Henning Bundgaard
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Lothar Faber
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
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Abstract
Hypertrophic cardiomyopathy is a genetic disorder characterized by marked hypertrophy of the myocardium. It is frequently accompanied by dynamic left ventricular outflow tract obstruction and symptoms of dyspnea, angina, and syncope. The initial therapy for symptomatic patients with obstruction is medical therapy with β-blockers and calcium antagonists. However, there remain a subset of patients who have continued severe symptoms, which are unresponsive to medical therapy. These patients can be treated with septal reduction therapy, either surgical septal myectomy or alcohol septal ablation. When performed by experienced operators working in high-volume centers, septal myectomy is highly effective with a >90% relief of obstruction and improvement in symptoms. The perioperative mortality rate for isolated septal myectomy in most centers is <1%. Alcohol septal ablation is a less invasive treatment. In many patients, the hemodynamic and clinical results are comparable to that of septal myectomy. However, the results of alcohol septal ablation are dependent on the septal perforator artery supplying the area of the contact between the hypertrophied septum and the anterior leaflet of the mitral valve. There are some patients, particularly younger patients with severe hypertrophy, who do not uniformly experience complete relief of obstruction and symptoms. Both techniques of septal reduction therapy are highly operator dependent. The final decision as to which approach should be selected in any given patient is dependent up patient preference and the availability and experience of the operator and institution at which the patient is being treated.
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Affiliation(s)
- Rick A Nishimura
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (R.A.N.); Medizinische Klinik 1, Leopoldina Krankenhaus, Schweinfurt, Germany (H.S.); and Department of Cardiovascular Surgery, Rochester, MN (H.V.S.).
| | - Hubert Seggewiss
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (R.A.N.); Medizinische Klinik 1, Leopoldina Krankenhaus, Schweinfurt, Germany (H.S.); and Department of Cardiovascular Surgery, Rochester, MN (H.V.S.)
| | - Hartzell V Schaff
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (R.A.N.); Medizinische Klinik 1, Leopoldina Krankenhaus, Schweinfurt, Germany (H.S.); and Department of Cardiovascular Surgery, Rochester, MN (H.V.S.)
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25
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An SY, Yang YJ, Hang F, Wang ZM, Fan CM. Procedural complication and long term outcomes after alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: data from China. Sci Rep 2017; 7:9506. [PMID: 28842653 PMCID: PMC5572739 DOI: 10.1038/s41598-017-10144-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022] Open
Abstract
Data on procedural complications and long term survival after alcohol septal ablation (ASA) in Chinese patients with obstructive hypertrophic cardiomyopathy (HOCM) are lacking. We aimed to investigate long-term survival of HOCM patients after ASA and compared to the non-obstructive hypertrophic cardiomyopathy(NOHCM). A total of 233 patients with HOCM and a peak pressure gradient of ≥50 mm Hg at rest or with provocation were consecutively enrolled from Fuwai Hospital in China between 2000 and 2012. Another 297 patients without left ventricular outflow tract obstruction were regarded as control group. Periprocedural mortality of ASA were low (0.89%). Periprocedural lethal ventricular arrhythmia occurred in 9 patients (4.0%). Alcohol volume (RR 1.44, 95% CI: 1.03–2.03, P = 0.034) and age ≤40 years old (RR 4.63, 95% CI: 1.07–20.0, P = 0.040) were independent predictors for periprocedural lethal ventricular arrhythmia. The 10- year overall survival was 94.6% in the ASA group, similar with 92.9% in the NOHCM group (P = 0.930). In conclusion, periprocedural mortality and complications were rare in ASA. Long term survival after ASA were satisfactory and comparable to NOHCM. Patients under 40 years old should be more cautious undergoing ASA, for these patients were more likely to endure lethal ventricular arrhythmia during periprocedural period of ASA.
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Affiliation(s)
- Shuo-Yan An
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin-Jian Yang
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Hang
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Min Wang
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao-Mei Fan
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Khalil J, Kuehl M, Davierwala P, Mohr FW, Misfeld M. Hypertrophic obstructive cardiomyopathy-the Leipzig experience. Ann Cardiothorac Surg 2017; 6:337-342. [PMID: 28944174 DOI: 10.21037/acs.2017.07.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Management of hypertrophic obstructive cardiomyopathy (HOCM) has evolved considerably over the last fifty years, and includes medical treatment as well as septal myectomy (SM) to relief symptoms caused by left ventricular outflow tract obstruction (LVOTO). We report the Leipzig Heart Center experience in the surgical management of patients with HOCM. METHODS We collected data from all patient treated surgically with a myectomy for LVOTO in patients with HOCM between 1997 and 2016. Patients with absent data were excluded from our analysis. All data were obtained from our surgical database and analyzed retrospectively. RESULTS We identified 115 patients who underwent surgical treatment for HOCM, where a male:female ratio of 1.1:1, a mean age of 60.8±14.6 years and a body mass index of 27.7±4.5 were observed. The most common symptom was dyspnea (n=102). Of all patients, 50% had New York Heart Association (NYHA) III class symptoms. Arterial hypertension was the most common comorbidity (n=80). Preoperative transthoracic echocardiography showed a mean ejection fraction (EF) of 65.9%±9.7%, median septal thickness of 21.1±5.3 mm, systolic anterior motion of the mitral valve (MV) in 61.7% of patients, and mean LVOT gradient of 70.1±45.2 mmHg. Surgery resulted in a mean decrease of the septal thickness by 15±3.7 mm and LVOT gradient by 9.7±8.5 mmHg. Isolated SM was carried out on 20 patients. Postoperatively, we were able to notice a significant improvement in NYHA classification, in which patients with NYHA III benefitted most from SM. Long-term follow-up data up to 11.3±0.7 years were available for 114 patients. During follow-up, 16 patients died, and one patient was lost to follow up. CONCLUSIONS Surgical treatment of LVOT in patients with HOCM is an effective intervention that improves cardiac function and quality of life (QoL) and is associated with a low operative risk.
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Affiliation(s)
- Jawad Khalil
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Michael Kuehl
- Department of Electrophysiology, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Pirose Davierwala
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | | | - Martin Misfeld
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
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Liebregts M, Faber L, Jensen MK, Vriesendorp PA, Januska J, Krejci J, Hansen PR, Seggewiss H, Horstkotte D, Adlova R, Bundgaard H, ten Berg JM, Veselka J. Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy. JACC Cardiovasc Interv 2017; 10:1134-1143. [DOI: 10.1016/j.jcin.2017.03.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/21/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
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Cooper R, Binukrishnan S, Shahzad A, Hasleton J, Sigwart U, Stables R. Computed tomography angiography planning identifies the target vessel for optimum infarct location and improves clinical outcome in alcohol septal ablation for hypertrophic obstructive cardiomyopathy. EUROINTERVENTION 2017; 12:e2194-e2203. [DOI: 10.4244/eij-d-15-00159] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Aksu T, Guler T, Yalin K, Golcuk SE, Ozcan K. Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: Transcoronary and Endocardial Approach. Am J Med Sci 2016; 352:466-471. [PMID: 27865293 DOI: 10.1016/j.amjms.2016.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022]
Abstract
Septal reduction therapy is the gold standard treatment method for symptomatic, hypertrophic obstructive cardiomyopathy. Although surgical myectomy is a well-established and effective technique with decades of experience in its application, use of transcoronary alcohol septal ablation has increased precipitously owing to the less-invasive nature of the procedure. Moreover, endocardial septal ablation therapy is a relatively newly defined modality, and outcomes of the procedure are not clearly elucidated yet. In this review, we aimed to present nonsurgical septal reduction approaches in patients with hypertrophic obstructive cardiomyopathy.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
| | - Tumer Guler
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Bayrampasa Kolan Hospital, Istanbul, Turkey
| | | | - Kazim Ozcan
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
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30
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Veselka J, Tomašov P, Januška J, Krejčí J, Adlová R. Obstruction after alcohol septal ablation is associated with cardiovascular mortality events. Heart 2016; 102:1793-1796. [PMID: 27587438 DOI: 10.1136/heartjnl-2016-309699] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/25/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Left ventricular outflow tract obstruction (≥30 mm Hg at rest; LVOTO) is considered a possible risk of long-term outcomes in patients with hypertrophic cardiomyopathy (HCM). However, the influence of LVOTO on the occurrence of cardiovascular mortality events in patients after alcohol septal ablation (ASA) for obstructive HCM remains unresolved. METHODS We compared the outcomes of patients treated with ASA with residual LVOTO <30 mm Hg with those with residual LVOTO ≥30 mm Hg at the first postdischarge check-up (1-6 months after the procedure). RESULTS A total of 270 patients (60±12 years, median follow-up 5.1 years; 95% CI 4.5 to 5.9 years) treated with a single ASA were included; 208 (77%) and 62 (23%) patients had post-ASA LVOTO <30 and ≥30 mm Hg at the first postdischarge clinical check-up, respectively (LVOTO 13±6 vs 50±27 mm Hg; p<0.01). Freedom from cardiovascular mortality events at 1, 5 and 10 years were 99% (95% CI 96% to 100%) vs 94% (95% CI 85% to 98%), 95% (95% CI 89% to 97%) vs 80% (95% CI 66% to 89%) and 82% (95% CI 69% to 89%) vs 72% (95% CI 55% to 84%) (log-rank test, p<0.01), respectively. In multivariable analysis adjusted for age at ASA, sex, baseline LVOTO and baseline septum thickness, the independent predictors of cardiovascular mortality events were early postdischarge LVOTO ≥30 mm Hg (HR 2.95, 95% CI 1.26 to 6.91; p=0.01) and baseline septum thickness (HR 1.07, 95% CI 1.01 to 1.13; p=0.02). CONCLUSIONS After ASA for obstructive HCM, LVOTO ≥30 mm Hg at the first postdischarge clinical check-up is associated with significantly higher occurrence of subsequent cardiovascular mortality events.
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Affiliation(s)
- Josef Veselka
- Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Pavol Tomašov
- Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Jaroslav Januška
- Department of Cardiology, Cardiocentre Podlesí, Třinec, Czech Republic
| | - Jan Krejčí
- 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre, St Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Radka Adlová
- Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
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Sawaya FJ, Louvard Y, Spaziano M, Morice MC, Hage F, El-Khoury C, Roy A, Garot P, Hovasse T, Benamer H, Unterseeh T, Chevalier B, Champagne S, Piechaud JF, Blanchard D, Cormier B, Lefèvre T. Short and long-term outcomes of alcohol septal ablation with the trans-radial versus the trans-femoral approach: A single center-experience. Int J Cardiol 2016; 220:7-13. [PMID: 27372037 DOI: 10.1016/j.ijcard.2016.06.127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/16/2016] [Accepted: 06/22/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although the trans-radial approach (TR) has been applied to various subsets of patients in percutaneous coronary intervention, the feasibility, efficacy, acute procedural and long-term outcomes of TR versus trans-femoral approach (TF) for alcohol septal ablation (ASA) have not yet been determined. OBJECTIVES The aim of this study was to compare the short and long-term outcomes of ASA with the TR approach compared to the TF approach. METHODS We retrospectively analyzed 240 patients who underwent an ASA procedure at our institution from November 1999 to November 2015. The TR approach was performed in 172 cases and the TF approach in the remaining 68 cases. RESULTS The use of TR approach progressively increased from 62% in 1999-2005 to 91% in 2011-2015 (p=0.0001). The TF and TR group had similar age, baseline NYHA class (NYHA 3 or 4) and mean left ventricular outflow tract peak gradient before ASA. Total contrast used (TR: 73.2±47.2ml; TF: 88.7±49.3ml, p=0.11), total radiation Air kerma area product (TR: 43.7±48.0Gycm(-2); TF: 55.9±48.2Gycm(-2); p=0.39) and peak left ventricular outflow tract gradient immediately after ASA (TR: 19.1±19.6mmHg; TF: 20.4±18.0mmHg, p=0.63) were similar in both groups. Procedural success was 91.9% and 91.2% in the TR and TF groups, respectively (p=0.53). At 30days, there was 2 intra-hospital death (1 in TF and 1 in TR), 1 major stroke in the TF group and 1 coronary artery dissection in the TR group. Vascular complications were less frequent in the TR group (0.58% vs. 7.3%; p=0.002). The mean length of follow-up was 4.56±4.34years (IQR 0.69-8.2; median 2.92years; maximum: 15.5years). By Kaplan-Meier estimate, the observed survival in the overall cohort was comparable to the expected survival for a sex and age-matched comparable general French population at 10years (86.9 vs. 83.6%, p=0.88). Survival was similar between the TR and TF group (92.1% vs. 89.7% at 6years, respectively; p=0.71). CONCLUSIONS Alcohol septal ablation from the radial approach can be performed with similar acute and long-term success, but with lower vascular complications compared to the femoral approach.
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Affiliation(s)
- Fadi J Sawaya
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Yves Louvard
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Marco Spaziano
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Marie-Claude Morice
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Fouad Hage
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Carlos El-Khoury
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Andrew Roy
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Philippe Garot
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Thomas Hovasse
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Hakim Benamer
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Thierry Unterseeh
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Bernard Chevalier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Stéphane Champagne
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Jean-François Piechaud
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Didier Blanchard
- Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Bertrand Cormier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Thierry Lefèvre
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
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Shelke AB, Menon R, Kapadiya A, Yalagudri S, Saggu D, Nair S, Narasimhan C. A novel approach in the use of radiofrequency catheter ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy. Indian Heart J 2016; 68:618-623. [PMID: 27773399 PMCID: PMC5079133 DOI: 10.1016/j.ihj.2016.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/30/2015] [Accepted: 02/07/2016] [Indexed: 11/30/2022] Open
Abstract
Objective Alcohol septal ablation (ASA) is a therapeutic alternative to surgical myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, the anatomical variability of the septal branch, risk of complete heart block, and late onset ventricular arrhythmias are limitations to its therapeutic usage. There is recent interest in the use of radiofrequency catheter ablation (RFCA) as a therapeutic option in HOCM. We aimed to assess the safety and efficacy of RFCA in the treatment of symptomatic HOCM. Methods Seven patients with symptomatic HOCM (mean age 43.7 ± 15.6 years, five males), and significant left ventricular outflow tract (LVOT) gradient despite optimal drug therapy, underwent ablation of the hypertrophied interventricular septum. These patients had unfavorable anatomy for ASA. Ablation was performed under 3D electro-anatomical system guidance using an open irrigated tip catheter. The region of maximal LV septal bulge as seen on intracardiac echocardiography was targeted. Patients were followed up at 1, 6, and 12 months post-procedure. Results The mean baseline LVOT gradient by Doppler echocardiography was 81 ± 14.8 mm of Hg which reduced to 48.5 ± 22.6 (p = 0.0004), 49.8 ± 19.3 (p = 0.0004), and 42.8 ± 26.1 mm of Hg (p = 0.05) at 1, 6, and 12 months respectively. Symptoms improved at least by one NYHA class in all but one patient. One patient developed transient pulmonary edema post-RFA. There were no other complications. Conclusion RFCA of the hypertrophied septum causes sustained reduction in the LVOT gradient and symptomatic improvement among patients with HOCM. Electroanatomical mapping helps to perform the procedure safely.
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Affiliation(s)
- Abhijeet B Shelke
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India
| | - Rajeev Menon
- Department of Cardiology, CARE Hospitals, Hyderabad, India
| | - Anuj Kapadiya
- Department of Cardiology, CARE Hospitals, Hyderabad, India
| | - Sachin Yalagudri
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India
| | - Daljeet Saggu
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India
| | - Sandeep Nair
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India
| | - C Narasimhan
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India.
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Moss TJ, Zipse MM, Krantz MJ, Sauer WH, Salcedo EE, Schuller JL. Incidence of Atrial Fibrillation following Alcohol Septal Ablation for Hypertrophic Cardiomyopathy. Ann Noninvasive Electrocardiol 2016; 21:443-9. [PMID: 26970562 DOI: 10.1111/anec.12335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) are at a fourfold to sixfold higher risk of developing atrial fibrillation (AF) compared to the general population, though incidence rates among patients undergoing alcohol septal ablation (ASA) are not well characterized. The purpose of this study was to evaluate atrial fibrillation incidence following ASA. METHODS We studied 132 consecutive HCM patients without comorbid AF that underwent 154 ASA procedures. The incidence of AF in follow-up was assessed through chart abstraction including electrocardiography. Survival free of AF was estimated using Kaplan-Meier methodology. RESULTS Over a mean follow-up of 3.6 ± 2.7 years (maximum 11.3 years), 10 (7.6%) patients developed new-onset AF. Of those who developed AF, both resting and provoked left ventricular outflow tract (LVOT) gradients had improved significantly (difference -79.78 mm Hg, P ≤ 0.005). Severity of mitral regurgitation improved in 7 (70%) patients. Survival free of AF was estimated to be 99.1%, 93.7%, and 91.7% at 1, 3, and 5 years. CONCLUSIONS Despite relieving LVOT obstruction and improving mitral regurgitation severity via ASA, new-onset AF remained a common complication of hypertrophic cardiomyopathy.
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Affiliation(s)
- Travis J Moss
- Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Matthew M Zipse
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mori J Krantz
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Cardiovascular Division, Denver Health Medical Center, Denver, CO
| | - William H Sauer
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ernesto E Salcedo
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Joseph L Schuller
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Cardiovascular Division, Denver Health Medical Center, Denver, CO
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Liebregts M, Vriesendorp PA, Steggerda RC, Schinkel AF, Balt JC, Ten Cate FJ, Michels M, Ten Berg JM. Effect of alcohol dosage on long-term outcomes after alcohol septal ablation in patients with hypertrophic cardiomyopathy. Catheter Cardiovasc Interv 2016; 88:945-952. [DOI: 10.1002/ccd.26448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/03/2015] [Accepted: 01/17/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Max Liebregts
- Department of Cardiology; St. Antonius Hospital Nieuwegein; Nieuwegein The Netherlands
| | - Pieter A. Vriesendorp
- Department of Cardiology; Erasmus Medical Center, Thoraxcenter; Rotterdam The Netherlands
| | | | - Arend F.L. Schinkel
- Department of Cardiology; Erasmus Medical Center, Thoraxcenter; Rotterdam The Netherlands
| | - Jippe C. Balt
- Department of Cardiology; St. Antonius Hospital Nieuwegein; Nieuwegein The Netherlands
| | - Folkert J. Ten Cate
- Department of Cardiology; Erasmus Medical Center, Thoraxcenter; Rotterdam The Netherlands
| | - Michelle Michels
- Department of Cardiology; Erasmus Medical Center, Thoraxcenter; Rotterdam The Netherlands
| | - Jurriën M. Ten Berg
- Department of Cardiology; St. Antonius Hospital Nieuwegein; Nieuwegein The Netherlands
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35
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Liebregts M, Vriesendorp PA, Mahmoodi BK, Schinkel AF, Michels M, ten Berg JM. A Systematic Review and Meta-Analysis of Long-Term Outcomes After Septal Reduction Therapy in Patients With Hypertrophic Cardiomyopathy. JACC-HEART FAILURE 2015; 3:896-905. [DOI: 10.1016/j.jchf.2015.06.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/09/2015] [Accepted: 06/12/2015] [Indexed: 11/15/2022]
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36
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Veselka J, Zemánek D, Jahnlová D, Krejčí J, Januška J, Dabrowski M, Bartel T, Tomašov P. Risk and Causes of Death in Patients After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy. Can J Cardiol 2015; 31:1245-51. [DOI: 10.1016/j.cjca.2015.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 01/28/2015] [Accepted: 02/13/2015] [Indexed: 01/27/2023] Open
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37
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Kitamura M, Takayama M, Matsuda J, Kubota Y, Nakamura S, Takano H, Asai K, Shimizu W. Clinical Characteristics and Outcome of Alcohol Septal Ablation With Confirmation by Nitroglycerin Test for Drug-Refractory Hypertrophic Obstructive Cardiomyopathy With Labile Left Ventricular Outflow Obstruction. Am J Cardiol 2015. [PMID: 26209114 DOI: 10.1016/j.amjcard.2015.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Careful evaluation, including provocation tests, is needed to specify an indication for septal reduction therapy in patients with drug-refractory hypertrophic obstructive cardiomyopathy. This study aimed to evaluate the outcome of alcohol septal ablation (ASA) using an intravenous nitroglycerin test (IV-NTG). Of consecutive 156 patients, after excluding cases of severe valvular disease and repeat septal reduction therapy, we investigated the clinical characteristics of patients with labile obstruction (n = 32) and the outcomes after ASA using the IV-NTG test; comparisons were made with those exhibiting basal obstruction (a resting gradient of ≥30 mm Hg). The patients with labile obstruction had less left ventricular mass (141 ± 47 vs 182 ± 59 g, p = 0.003) and less brain natriuretic peptide values (414 ± 576 vs 744 ± 625 pg/ml, p <0.001) than those with basal obstruction. Immediately after ASA, the gradients improved from 15 ± 7 to 5 ± 5 mm Hg and the IV-NTG-provoked gradients improved from 74 ± 25 to 13 ± 9 mm Hg, respectively. At 1-year follow-up, the New York Heart Association functional class had improved from 2.7 ± 0.5 to 1.3 ± 0.5. There was no sudden cardiac death during the follow-up period (5.1 ± 3.0 years), and 8-year survival free from cardiovascular death was 94%. In conclusion, patients with labile obstruction had less-severe left ventricular hypertrophy but exhibited symptoms comparable to those with basal obstruction. The IV-NTG test is a useful method for rapidly confirming acute reduction of the latent gradient after the ASA procedure, and the outcome of ASA for labile obstruction was favorable.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan.
| | | | - Junya Matsuda
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Shunichi Nakamura
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
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38
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Cooper RM, Shahzad A, Stables RH. Intervention in HCM: patient selection, procedural approach and emerging techniques in alcohol septal ablation. Echo Res Pract 2015; 2:R25-35. [PMID: 26693329 PMCID: PMC4676471 DOI: 10.1530/erp-14-0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/30/2014] [Indexed: 11/08/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a highly heterogeneous disease with varied patterns of hypertrophy. Basal septal hypertrophy and systolic anterior motion (SAM) of the mitral valve (MV) are the key pathophysiological components to left ventricular outflow tract (LVOT) obstruction in HCM. LVOT is associated with higher morbidity and mortality in patients with HCM. Percutaneous septal reduction therapy with alcohol septal ablation (ASA) can lead to a significant improvement in left ventricle haemodynamics, patient symptoms and perhaps prognosis. ASA delivers pure alcohol to an area of myocardium via septal coronary arteries; this creates damage to tissue akin to a myocardial infarction. The basal septal myocardium involved in SAM-septal contact is the target for this iatrogenic infarct. Appropriate patient selection and accurate delivery of alcohol are critical to safe and effective ASA. Securing the correct diagnosis and ensuring suitable cardiac anatomy are essential before considering ASA. Pre-procedural planning and intra-procedural imaging guidance are important to delivering precise damage to the desired area. The procedure is performed worldwide and is generally safe; the need for a pacemaker is the most prominent complication. It is successful in the majority of patients but room for improvement exists. New techniques have been proposed to perform percutaneous septal reduction. We present a review of the relevant pathophysiology, current methods and a summary of available evidence for ASA. We also provide a glimpse into emerging techniques to deliver percutaneous septal reduction therapy.
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Affiliation(s)
- Robert M Cooper
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital , Thomas Drive, Liverpool, L14 3PE , UK
| | - Adeel Shahzad
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital , Thomas Drive, Liverpool, L14 3PE , UK
| | - Rodney H Stables
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital , Thomas Drive, Liverpool, L14 3PE , UK
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39
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Veselka J. Twenty years of alcohol septal ablation document more than a history of a single interventional procedure. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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40
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Long-Term Outcomes After Medical and Invasive Treatment in Patients With Hypertrophic Cardiomyopathy. JACC-HEART FAILURE 2014; 2:630-6. [DOI: 10.1016/j.jchf.2014.06.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/30/2014] [Accepted: 06/13/2014] [Indexed: 11/16/2022]
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41
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Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2733-79. [PMID: 25173338 DOI: 10.1093/eurheartj/ehu284] [Citation(s) in RCA: 2894] [Impact Index Per Article: 289.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Ablation Techniques/methods
- Adult
- Angina Pectoris/etiology
- Arrhythmias, Cardiac/etiology
- Cardiac Imaging Techniques/methods
- Cardiac Pacing, Artificial/methods
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/therapy
- Child
- Clinical Laboratory Techniques/methods
- Death, Sudden, Cardiac/prevention & control
- Delivery of Health Care
- Diagnosis, Differential
- Electrocardiography/methods
- Female
- Genetic Counseling/methods
- Genetic Testing/methods
- Heart Failure/etiology
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Medical History Taking/methods
- Pedigree
- Physical Examination/methods
- Preconception Care/methods
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prenatal Care/methods
- Risk Factors
- Sports Medicine
- Syncope/etiology
- Thoracic Surgical Procedures/methods
- Ventricular Outflow Obstruction/etiology
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42
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Kimmelstiel C, Kapur NK. Low alcohol tolerance--a blessing for septal ablation. Catheter Cardiovasc Interv 2014; 84:108-9. [PMID: 24975263 DOI: 10.1002/ccd.25537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Carey Kimmelstiel
- Cardiac Catheterization Laboratory, Division of Cardiology, and Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA
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43
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Moss TJ, Krantz MJ, Zipse MM, Quaife RA, Sauer WH, Messenger JC, Groves BM, Salcedo EE, Schuller JL. Left ventricular systolic function following alcohol septal ablation for symptomatic hypertrophic cardiomyopathy. Am J Cardiol 2014; 113:1401-4. [PMID: 24576545 DOI: 10.1016/j.amjcard.2014.01.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/25/2022]
Abstract
Because alcohol septal ablation (ASA) for the treatment of symptomatic hypertrophic cardiomyopathy (HC) with left ventricular (LV) outflow tract (LVOT) obstruction results in a myocardial infarct of up to 10% of ventricular mass, LV systolic function could decline over time. We evaluated LV function during longitudinal follow-up in a cohort of patients who underwent ASA. We studied 145 consecutive patients with HC that underwent 167 ASA procedures from 2002 to 2011. Echocardiographic follow-up was available in 139 patients (96%). Echocardiographic indexes included LV ejection fraction (LVEF), mitral regurgitation severity, systolic anterior motion of the anterior mitral leaflet, and resting and provoked LVOT gradients. All patients had a baseline LVEF of >55%. LVEF was preserved in 97.1% of patients over a mean follow-up time of 3.1±2.3 years (maximum 9.7). Mild LV systolic dysfunction was observed (LVEF range 44% to 54%) in only 4 patients. Mitral regurgitation severity improved in 67% (n=112 of 138 with complete data). Resting LVOT gradient declined from a mean of 75 to 19 mm Hg (p<0.001), and provoked gradient declined from a mean of 101 to 33 mm Hg (p<0.001). New York Heart Association class improved from a mean of 2.9±0.4 to 1.3±0.5 (p<0.001). In conclusion, LV systolic function is only mildly reduced in a minority of patients after ASA for symptomatic HC; other echocardiographic and functional measures were significantly improved.
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44
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Veselka J, Krejčí J, Tomašov P, Jahnlová D, Honěk T, Januška J, Branny M, Zemánek D. Survival of patients ≤ 50 years of age after alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Can J Cardiol 2014; 30:634-8. [PMID: 24882534 DOI: 10.1016/j.cjca.2014.03.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/31/2014] [Accepted: 03/31/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The long-term efficacy and safety of alcohol septal ablation (ASA) has recently been demonstrated. However, there is still debate about the outcome of younger patients who should be treated using myectomy, according to American College of Cardiology Foundation/American Heart Association guidelines. The aim of this study was to evaluate the long-term outcome of patients ≤ 50 years of age after ASA for hypertrophic obstructive cardiomyopathy (HOCM). METHODS We retrospectively evaluated consecutive, highly symptomatic patients aged ≤ 50 years with HOCM who underwent ASA. RESULTS Institutional databases of 3 cardiovascular centres identified 290 patients with HOCM who underwent ASA; 75 (26%) of them were aged ≤ 50 years at the time of their first ASA. Median duration of follow-up was 5.1 years (range, 0.1-15.4 years). Four patients (5%) died during the study period (438 patient-years; the annual mortality rate was 0.91%; 95% confidence interval [CI], 0.25-2.34%; the annual mortality rate combined with the first appropriate implantable cardioverter-defibrillator discharge was 1.43%; 95% CI, 0.52-3.10%). Survival free of all-cause mortality at 1, 5, and 10 years was 97% (95% CI, 89-99%), 94% (95% CI, 84-98%), and 94% (95% CI, 84-98%), respectively. CONCLUSIONS Results of this first study focused on HOCM patients aged ≤ 50 years who underwent ASA suggest a low risk of all-cause death or appropriate implantable cardioverter-defibrillator discharge in the long-term follow-up.
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Affiliation(s)
- Josef Veselka
- Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
| | - Jan Krejčí
- First Department of Internal Medicine/Cardioangiology, Masaryk University, International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Pavol Tomašov
- Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Denisa Jahnlová
- Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Tomáš Honěk
- First Department of Internal Medicine/Cardioangiology, Masaryk University, International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | | | - Marian Branny
- Cardiocenter Trinec, Hospital Podlesi, Trinec, Czech Republic
| | - David Zemánek
- Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
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Veselka J, Krej i J, Toma ov P, Zemanek D. Long-term survival after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a comparison with general population. Eur Heart J 2014; 35:2040-5. [DOI: 10.1093/eurheartj/eht495] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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46
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Fiarresga A, Cacela D, Galrinho A, Ramos R, de Sousa L, Bernardes L, Patrício L, Cruz Ferreira R. Ablação septal alcoólica no tratamento da cardiomiopatia hipertrófica obstrutiva - experiência de quatro anos de um centro. Rev Port Cardiol 2014; 33:1-10. [DOI: 10.1016/j.repc.2013.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/25/2013] [Indexed: 10/25/2022] Open
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47
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Alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Four years of experience at a reference center. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Veselka J. Historical Milestones and Progress in the Research on Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy. Can J Cardiol 2014; 30:46-51. [DOI: 10.1016/j.cjca.2013.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 11/28/2022] Open
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49
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Sathyamurthy I, Nayak R, Oomman A, Subramanyan K, Kalarical MS, Mao R, Ramachandran P. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy - 8 years follow up. Indian Heart J 2013; 66:57-63. [PMID: 24581097 PMCID: PMC5125590 DOI: 10.1016/j.ihj.2013.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 11/18/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Abstract
Background Alcohol septal ablation is emerging as an alternative to surgical myectomy in the management of symptomatic cases of Hypertrophic obstructive cardiomyopathy (HOCM). This involves injection of absolute alcohol into 1st septal perforator thereby producing myocardial necrosis with resultant septal remodelling within 3–6 months. This results in reduction of septal thickness and LV outflow gradients with improvement in symptoms. Methods Fifty three patients had undergone alcohol septal ablation, there were 2 early and 2 late deaths and 4 patients lost to follow up. Forty-five (85%) of them were followed up to a mean period of 96 ± 9.2 months. Clinical, ECG, and Echocardiographic parameters were evaluated during follow up. Results Only 4 out of 51 patients remained in NYHA class III or IV at the end of 6 months. Significant reduction of LV outflow gradients (79 ± 35 to 34 ± 23 mmHg) and septal thickness (23 ± 4.7 mm to 19 ± 3 mm) were observed during 6 months follow up. Beyond 6 months there was no further decrease in either septal thickness or LVOT gradients noted. Ten percent of patients needed pacemaker implantation. There was 92% survival at the end of 8 years. Conclusion Alcohol septal ablation is a safe and effective nonsurgical procedure for the treatment of HOCM. By minimizing the amount of alcohol to ≤2 ml, one can reduce complications and mortality. The long-term survival is gratifying.
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Affiliation(s)
- I Sathyamurthy
- Sr. Interventional Cardiologist & Director, Dept of Cardiology, Apollo Hospitals, Chennai 600006, India.
| | - Rajeshwari Nayak
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
| | - Abraham Oomman
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
| | - K Subramanyan
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
| | | | - Robert Mao
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
| | - P Ramachandran
- Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India
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50
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Veselka J, Lawrenz T, Stellbrink C, Zemanek D, Branny M, Januska J, Sitar J, Dimitrow P, Krejci J, Dabrowski M, Mizera S, Bartel T, Kuhn H. Early outcomes of alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Catheter Cardiovasc Interv 2013; 84:101-7. [DOI: 10.1002/ccd.25236] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/10/2013] [Accepted: 09/24/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Josef Veselka
- Department of Cardiology2nd Medical School, Charles University and University Hospital MotolPrague Czech Republic
| | - Thorsten Lawrenz
- Klinikum Bielefeld‐Mitte, Department of Cardiology and Internal Intensive Care, BielefeldUniversity of Witten/Herdecke Germany
- Department of CardiologyUniversity of Witten/Herdecke Germany
| | - Christoph Stellbrink
- Klinikum Bielefeld‐Mitte, Department of Cardiology and Internal Intensive Care, BielefeldUniversity of Witten/Herdecke Germany
- Department of CardiologyUniversity of Witten/Herdecke Germany
| | - David Zemanek
- Department of Cardiology2nd Medical School, Charles University and University Hospital MotolPrague Czech Republic
- 1st Department of Internal Medicine/CardioangiologyInternational Clinical Research Centre–St. Anne's University HospitalBrno Czech Republic
| | - Marian Branny
- Department of CardiologyPodlesi HospitalTrinec Czech Republic
| | | | - Jan Sitar
- Department of CardiologyVarna Bulgaria
| | - Pawel Dimitrow
- 2nd Department of Cardiology, Collegium MedicumJagiellonian UniversityCracow Poland
| | - Jan Krejci
- 1st Department of Internal Medicine/CardioangiologyInternational Clinical Research Centre–St. Anne's University HospitalBrno Czech Republic
| | - Maciej Dabrowski
- Department of Interventional Cardiology and AngiologyInstitute of CardiologyWarsaw Poland
| | - Stanislav Mizera
- Department of CardiologyNational Institute of Cardiovascular DiseasesBratislava Slovakia
| | - Thomas Bartel
- Department of Internal Medicine IIIMedical University Innsbruck Austria
| | - Horst Kuhn
- Klinikum Bielefeld‐Mitte, Department of Cardiology and Internal Intensive Care, BielefeldUniversity of Witten/Herdecke Germany
- Department of CardiologyUniversity of Witten/Herdecke Germany
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