Gender-Based Outcome Discrepancies in Patients Who Underwent Alcohol Septal Ablation or Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

Saravanabavanandan, Ragavendar; Jaimalani, Aniket; Khan, Muhammad Ahsan Naseer; Riaz, Sania; Mangas, Gabriel de Moraes; Ahsan, Syed Muhammad; Posani, Sarojini; Patel, Tirath; Fawad, Moiz; Al-Tawil, Mohammed

doi:10.1016/j.amjcard.2023.09.033

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…atrioventricular block) than men. This is supported by a study by Saravanabavanandan et al shown that women have higher short-term all-cause mortality, incidence of atrioventricular block, permanent pacemaker implantation and hospital stay after ASA or myectomy, compared to men [19]. In both, this study and the study by Saravanabavanandan et al, women were older at the time of the procedure.…”

Section: Discussionsupporting

confidence: 73%

Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: do sex, mitral valve leaflet length and septal thickness affect the outcome?

Mustafic,

Jandér,

Marlevi

et al. 2024

Preprint

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PurposeThis retrospective cohort study aimed to assess whether basal septal wall thickness (BSWT), anterior (AML) and posterior (PML) mitral leaflet length, or sex were associated with remaining left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA).Methods154 patients that underwent ASA at the Karolinska University Hospital in Stockholm, Sweden, between 2009 and 2021, were retrospectively included. Anatomical and hemodynamic parameters were collected from invasive catheterization before and during ASA, and from echocardiography (ECHO) examinations before, during, and at one-year follow-up after ASA. Linear and logistic regression models were used to assess the association between sex, BSWT, AML, PML, and outcome defined as remaining LVOTO (>30 mmHg) after ASA.ResultsThe median follow-up was 364 days (IQR 334-385 days). BSWT>23 mm (n=13, 12%) was associated with remaining LVOTO at follow-up (p=0.004). Elongated MVLL (either AML or PML) was present in 125 (90%) of the patients. Elongated AML (>24 mm) was present in 67 (44%) of the patients, although AML length was not associated with remaining LVOTO at follow-up. Elongated PML (>14 mm) was present in 114 (74%) and not associated with remaining LVOTO at follow-up. No significant sex differences were observed regarding remaining LVOTO.ConclusionECHO measurement of BSWT can be used effectively for patient selection for successful ASA and for identification of patients with a risk of incomplete resolution of LVOTO after ASA.

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Section: Discussionsupporting

confidence: 73%

Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: do sex, mitral valve leaflet length and septal thickness affect the outcome?

Mustafic,

Jandér,

Marlevi

et al. 2024

Preprint

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“…necessidade de reintervenção, implante de MP(OSMAN et al, 2019). Quando se comparou o risco a curto prazo para todas as causas na população feminina, estas apresentaram maior probabilidade de apresentarem BAV e necessidade de implante de MP, maior tempo em internações hospitalares para ambas coortes de tratamento(SARAVANABAVANANDAN et al, 2023), comparativamente aos homens. Combinada com a MS, a plastia de VM pode ser uma estratégia de tratamento segura e viável em pacientes selecionados, necessitando ainda avaliar o benefício clínico a longo prazo(MIHOS et al, 2021).BYTYÇI et al, 2020 compararam a eficácia dos procedimentos ASA e MS através de busca em todas as bases de dados eletrônicas até fevereiro de 2020 para ensaios clínicos e coortes comparando desfechos clínicos em pacientes com CMHO.…”

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Miectomia Septal E Ablação Septal Alcoólica Para Controle Clínico De Pacientes Com Cardiomiopatia Hipertrófica Obstrutiva: Uma Revisão Integrativa

Girardi,

Vieira,

Andrade

et al. 2024

Rev. Foco

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INTRODUÇÃO: Sintomas da cardiomiopatia hipertrófica resultam de disfunção ventricular diastólica, desequilíbrio entre oferta e demanda de oxigênio, arritmias cardíacas, obstrução ao fluxo ventricular esquerdo. A principal causa de obstrução é a hipertrofia anormal do septo interventricular, associada à movimentação sistólica do folheto anterior da valva mitral, músculo papilar e cordoalhas tendíneas. Opções terapêuticas para casos refratários incluem a miectomia septal e ablação septal alcoólica. OBJETIVO: identificar através de busca bibliográfica, desfechos clínicos nos pacientes com cardiomiopatia hipertrófica obstrutiva, tratados por miectomia septal ou ablação septal alcoólica. METODOLOGIA: Revisão integrativa baseada na questão norteadora “quais são os desfechos clínicos das estratégias terapêuticas em pacientes sintomáticos com cardiomiopatia hipertrófica obstrutiva, miectomia e alcoolização de artéria septal?”. Busca de dados realizada nos bancos de dados: PUBMED, EMBASE, SCOPUS, Cochrane e Web of Science em dezembro de 2023, artigos de meta-análise e revisão sistemática nos últimos 5 anos, textos completos, acesso gratuito, língua inglesa, utilizando termos "cardiomyopathy, hypertrophic" AND "cardiovascular surgical procedures" OR "surgical myectomy" OR "septal myectomy" OR "alcohol septal ablation" AND "treatment outcome”. RESULTADOS: 3.136 foram os artigos identificados e apenas 4 selecionados por atenderem aos critérios. CONCLUSÕES: Autores concluem que ambas opções apresentam alto grau de segurança e risco semelhante de mortalidade, a ablação associou-se a aumento significativo de taxas de implantes de marcapasso definitivo, reoperações, maior gradiente residual. A mortalidade peri-procedimento foi maior para a miectomia septal, mas em 5 anos apresentou um desfecho favorável. Estratégia a ser escolhida deve ser guiada por discussões interdisciplinares, experiência da equipe, desejos e quadro clínico do paciente.

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Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: do mitral valve leaflet length, septal thickness, or sex affect the outcome?

Mustafic,

Jandér,

Marlevi

et al. 2024

Cardiovasc Interv and Ther

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This retrospective cohort study aimed to assess whether basal septal wall thickness (BSWT), anterior (AML) and posterior (PML) mitral leaflet length, or sex were associated with remaining left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA). One hundred fifty-four patients who underwent ASA at the Karolinska University Hospital in Stockholm, Sweden, between 2009 and 2021, were included retrospectively. Anatomical and hemodynamic parameters were collected from invasive catheterization before and during ASA, and from echocardiography (ECHO) examinations before, during, and at 1-year follow-up after ASA. Linear and logistic regression models were used to assess the association between sex, BSWT, AML, PML, and outcome, which was defined as the remaining LVOTO (≥ 30 mmHg) after ASA. The median follow-up was 364 days (interquartile range 334–385 days). BSWT ≥ 23 mm (n = 13, 12%) was associated with remaining LVOTO at follow-up (p = 0.004). Elongated mitral valve leaflet length (either AML or PML) was present in 125 (90%) patients. Elongated AML (> 24 mm) was present in 67 (44%) patients, although AML length was not associated with remaining LVOTO at follow-up. Elongated PML (> 14 mm) was present in 114 (74%) patients and was not associated with remaining LVOTO at follow-up. No significant sex differences were observed regarding the remaining LVOTO. ECHO measurement of BSWT can be effectively used to select patients for successful ASA and identify those patients with a risk of incomplete resolution of LVOTO after ASA. Graphical abstract

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Gender-Based Outcome Discrepancies in Patients Who Underwent Alcohol Septal Ablation or Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

Cited by 3 publications

References 30 publications

Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: do sex, mitral valve leaflet length and septal thickness affect the outcome?

Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: do sex, mitral valve leaflet length and septal thickness affect the outcome?

Miectomia Septal E Ablação Septal Alcoólica Para Controle Clínico De Pacientes Com Cardiomiopatia Hipertrófica Obstrutiva: Uma Revisão Integrativa

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: do mitral valve leaflet length, septal thickness, or sex affect the outcome?

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