Publication details

Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry

Authors

VESELKA Josef JENSEN Morten Kvistholm LIEBREGTS Max JANUSKA Jaroslav KREJČÍ Jan BARTEL Thomas DABROWSKI Maciej HANSEN Peter Riis ALMAAS Vibeke Marie SEGGEWISS Hubert HORSTKOTTE Dieter TOMASOV Pavol ADLOVA Radka BUNDGAARD Henning STEGGERDA Robbert BERG Jurriën ten FABER Lothar

Year of publication 2016
Type Article in Periodical
Magazine / Source European heart journal
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1093/eurheartj/ehv693
Field Cardiovascular diseases incl. cardiosurgery
Keywords Alcohol septal ablation; Prognosis; Survival
Description Aims The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. Methods and results We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58+/-14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 +/- 36 to 16 +/- 21 mmHg (P, 0.01) and NYHA class from 2.9 +/- 0.5 to 1.6 +/- 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class <= 2, which was independently associated with LV outflow tract gradient (P < 0.01). Conclusions The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient.

You are running an old browser version. We recommend updating your browser to its latest version.

More info