J 2016

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

VESELKA, Josef, Morten Kvistholm JENSEN, Max LIEBREGTS, Jaroslav JANUSKA, Jan KREJČÍ et. al.

Basic information

Original name

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

Authors

VESELKA, Josef (203 Czech Republic), Morten Kvistholm JENSEN (208 Denmark), Max LIEBREGTS (528 Netherlands), Jaroslav JANUSKA (203 Czech Republic), Jan KREJČÍ (203 Czech Republic, guarantor, belonging to the institution), Thomas BARTEL (40 Austria), Maciej DABROWSKI (616 Poland), Peter Riis HANSEN (208 Denmark), Vibeke Marie ALMAAS (578 Norway), Hubert SEGGEWISS (276 Germany), Dieter HORSTKOTTE (276 Germany), Pavol TOMASOV (203 Czech Republic), Radka ADLOVA (203 Czech Republic), Henning BUNDGAARD (208 Denmark), Robbert STEGGERDA (528 Netherlands), Jurriën ten BERG (528 Netherlands) and Lothar FABER (276 Germany)

Edition

European heart journal, Oxford, Oxford University Press, 2016, 0195-668X

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 20.212

RIV identification code

RIV/00216224:14110/16:00090787

Organization unit

Faculty of Medicine

DOI

UT WoS

000376167800012

Keywords in English

Alcohol septal ablation; Prognosis; Survival

Tags

Tags

International impact, Reviewed
Změněno: 12/9/2016 12:51, Ing. Mgr. Věra Pospíšilíková

Abstract

V originále

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.