Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy: Outcomes in Young, Middle-Aged, and Elderly Patients

被引:14
作者
Leonardi, Robert A. [1 ]
Townsend, Jacob C. [1 ]
Patel, Chetan A. [1 ]
Wolf, Bethany J. [1 ]
Todoran, Thomas M. [1 ]
Powers, Eric R. [1 ]
Steinberg, Daniel H. [1 ]
Fernandes, Valerian L. [1 ]
Nielsen, Christopher D. [1 ]
机构
[1] Med Univ S Carolina, Dept Med, Charleston, SC 29425 USA
关键词
hypertrophic cardiomyopathy; alcohol septal ablation; age; PERCUTANEOUS CORONARY INTERVENTION; SUDDEN CARDIAC DEATH; COMPLETE HEART-BLOCK; TRANSCORONARY ABLATION; RISK STRATIFICATION; PREVENTION; DEFIBRILLATORS; METAANALYSIS; PREDICTORS; MYECTOMY;
D O I
10.1002/ccd.24643
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
ObjectivesWe compared the efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) in young, middle-aged, and elderly patients. BackgroundIntersociety guidelines suggest based on limited evidence that young patients with medically refractory symptoms of obstructive HCM should undergo surgical myectomy while elderly patients may be more appropriate for ASA. MethodsData for 360 patients undergoing 389 ASAs were prospectively collected and retrospectively analyzed according to age. ResultsYoung (<45 years), middle-aged (45-64 years), and elderly (65 years) patients comprised 28, 40, and 32% of the study population, respectively. Young patients had thicker left ventricular septal walls at baseline, and elderly patients had more comorbidity and dyspnea. Resting, mean left ventricular outflow tract gradients (LVOTGs) were similar across the age groups at baseline (62, 66, and 68 mm Hg, respectively; P = NS for all comparisons). LVOTGs and dyspnea were significantly and similarly improved in all age groups immediately after ASA and through 12 months of follow-up (P < 0.001 for before and after comparisons; P = NS for intergroup comparisons). Complication rates were similar for young and middle-aged patients but higher for elderly patients (9.1 and 6.3% vs. 20.8%, respectively; P 0.016 for elderly vs. others). Mortality rates for young and middle-aged patients were lower than for elderly patients, but the differences were not statistically significant. ConclusionsPatients undergoing ASA had significant and similar improvements in LVOTGs and symptoms regardless of age. Procedural complications were increased in elderly patients, who had numerically but not statistically significantly higher mortality rates. (c) 2012 Wiley Periodicals, Inc.
引用
收藏
页码:838 / 845
页数:8
相关论文
共 23 条
[1]   Updated Meta-Analysis of Septal Alcohol Ablation Versus Myectomy for Hypertrophic Cardiomyopathy [J].
Agarwal, Shikhar ;
Tuzcu, E. Murat ;
Desai, Milind Y. ;
Smedira, Nicholas ;
Lever, Harry M. ;
Lytle, Bruce W. ;
Kapadia, Samir R. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 55 (08) :823-834
[2]   Echocardiography-guided genetic testing in hypertrophic cardiomyopathy: Septal morphological features predict the presence of myofilament mutations [J].
Binder, J ;
Ommen, SR ;
Gersh, BJ ;
Van Driest, SL ;
Tajik, AJ ;
Nishimura, RA ;
Ackerman, MJ .
MAYO CLINIC PROCEEDINGS, 2006, 81 (04) :459-467
[3]   Role of Family History of Sudden Death in Risk Stratification and Prevention of Sudden Death With Implantable Defibrillators in Hypertrophic Cardiomyopathy [J].
Bos, J. Martijn ;
Maron, Barry J. ;
Ackerman, Michael J. ;
Haas, Tammy S. ;
Sorajja, Paul ;
Nishimura, Rick A. ;
Gersh, Bernard J. ;
Ommen, Steve R. .
AMERICAN JOURNAL OF CARDIOLOGY, 2010, 106 (10) :1481-1486
[4]   Complete heart block: Determinants and clinical impact in patients with hypertrophic obstructive cardiomyopathy undergoing nonsurgical septal reduction therapy [J].
Chang, SM ;
Nagueh, SF ;
Spencer, WH ;
Lakkis, NM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 42 (02) :296-300
[5]   One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response [J].
Faber, L. ;
Welge, D. ;
Fassbender, D. ;
Schmidt, H. K. ;
Horstkotte, D. ;
Seggewiss, H. .
CLINICAL RESEARCH IN CARDIOLOGY, 2007, 96 (12) :864-873
[6]   2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [J].
Gersh, Bernard J. ;
Maron, Barry J. ;
Bonow, Robert O. ;
Dearani, Joseph A. ;
Fifer, Michael A. ;
Link, Mark S. ;
Naidu, Srihari S. ;
Nishimura, Rick A. ;
Ommen, Steve R. ;
Rakowski, Harry ;
Seidman, Christine E. ;
Towbin, Jeffrey A. ;
Udelson, James E. ;
Yancy, Clyde W. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2011, 142 (06) :E153-E203
[7]   Transcoronary ablation of septal hypertrophy for hypertrophic obstructive cardiomyopathy: feasibility, clinical benefit, and short term results in elderly patients [J].
Gietzen, FH ;
Leuner, CJ ;
Obergassel, L ;
Strunk-Mueller, C ;
Kuhn, H .
HEART, 2004, 90 (06) :638-644
[8]   Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: A systematic review and meta-analysis of randomized trials [J].
Jolly, Sanjit S. ;
Amlani, Shoaib ;
Hamon, Martial ;
Yusuf, Salim ;
Mehta, Shamir R. .
AMERICAN HEART JOURNAL, 2009, 157 (01) :132-140
[9]   Long-Term Outcomes in High-Risk Symptomatic Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation [J].
Kwon, Deborah H. ;
Kapadia, Samir R. ;
Tuzcu, E. Murat ;
Halley, Carmel M. ;
Gorodeski, Eiran Z. ;
Curtin, Ronan J. ;
Thamilarasan, Maran ;
Smedira, Nicholas G. ;
Lytle, Bruce W. ;
Lever, Harry M. ;
Desai, Milind Y. .
JACC-CARDIOVASCULAR INTERVENTIONS, 2008, 1 (04) :432-438
[10]   Predictors of complete heart block after transcoronary ablation of septal hypertrophy - Results of a prospective electrophysiological investigation in 172 patients with hypertrophic obstructive cardiomyopathy [J].
Lawrenz, Thorsten ;
Lieder, Frank ;
Bartelsmeier, Markus ;
Leuner, Christian ;
Borchert, Bianca ;
Meyer zu Vilsendorf, Dorothee ;
Strunk-Mueller, Claudia ;
Reinhardt, Jens ;
Feuchtl, Andre ;
Stellbrink, Christoph ;
Kuhn, Horst .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 49 (24) :2356-2363