Long-Term Prognosis after Myectomy in Hypertrophic Obstructive Cardiomyopathy with Severe Left Ventricular Hypertrophy

An, Shuoyan; Fan, Chaomei; Yang, Yujun; Hang, Fei; Wang, Zhimin; Zhang, Yuhui; Zhang, Jian

doi:10.1159/000484628

Cited by 4 publications

(4 citation statements)

References 35 publications

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“…Eighteen studies were for SM and seven studies were for ERASH. For SM cohorts, five studies (28%) were from European centers (544 patients) ( 18 , 21 , 24 , 27 , 28 ), five studies (28%) from North American centers (1,187 patients) ( 12 , 15 , 16 , 20 , 25 ), five studies (28%) from China (650 patients) ( 13 , 14 , 17 , 26 , 29 ), and the remaining three studies from Argentina (28 patients) ( 37 ), Turkey (41 patients) ( 22 ), and Bangladesh (21 patients) ( 23 ). For ERASH cohorts, three studies (43%) were from European centers (56 patients) ( 30 , 31 , 36 ), two studies (29%) from North American centers (16 patients) ( 32 , 34 ), and the remaining two studies from China (30 patients) ( 35 ) and India (7 patients) ( 33 ).…”

Section: Resultsmentioning

confidence: 99%

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Endocardial Radiofrequency Ablation vs. Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

et al. 2022

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BackgroundSeptal myectomy (SM) has been the gold standard therapy for most patients with hypertrophic obstructive cardiomyopathy (HOCM). Endocardial radiofrequency ablation of septal hypertrophy (ERASH) is a novel treatment for septal reduction. We aimed to assess the efficacy and safety between two treatment strategies.MethodsWe searched PubMed, Web of Science, Cochrane Library, and Embase databases to identify relevant studies published up to March 2021. Random-effect models were used to calculate standardized mean difference (SMD) and 95% confidence intervals (CIs) for resting left ventricular outflow tract gradient (LVOTG) and septal thickness.ResultsTwenty-five studies are included in this review, eighteen studies for SM and seven studies for ERASH. During follow-up, there were significant reductions of the mean resting LVOTG in adults (SM groups: SMD = −3.03, 95% CI [−3.62 to −2.44]; ERASH groups: SMD = −1.95, 95% CI [−2.45 to −1.45]) and children (SM groups: SMD = −2.67, 95% CI [−3.21 to −2.12]; ERASH groups: SMD= −2.37, 95% CI [−3.02 to −1.73]) after the septal reduction therapies. For adults, SM groups contributed to more obvious reduction than ERASH groups in interventricular septal thickness (SM groups: SMD = −1.82, 95% CI [−2.29 to −1.34]; ERASH groups: SMD = −0.43, 95% CI [−1.00 to 0.13]). The improvement of the New York Heart Association class was similar in the two groups (SM groups: 46.4%; ERASH groups: 46.7%). The periprocedural mortality in SM and ERASH were 1.1 and 1.8%, respectively.ConclusionsThis systematic review suggests that SM is superior to ERASH in the treatment of HOCM. But for the patients who are at risk for open cardiac surgeries or prefer a less invasive approach, ERASH might be an optional approach.

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Section: Resultsmentioning

confidence: 99%

“…Based on the currently available publications, it seems that ERASH is mainly being carried out in Germany and the UK ( 30 , 31 , 36 ), and SM is now performed more frequently by China centers ( 13 , 14 , 17 , 26 , 29 ). The surgical SM centers in Europe are not as active as they used to be.…”

Section: Discussionmentioning

confidence: 99%

Endocardial Radiofrequency Ablation vs. Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

et al. 2022

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“…LVOT obstruction is reported to be associated with symptom progression and increased mortality in HCM patients and is an independent predictor of adverse outcomes, arrhythmias, and SCD [ 1 , 5 , 13 ]. However, the incidence of cardiovascular mortality/cardiac transplantation and SCD in patients with HOCM varies between studies [ 2 , 14 ]. The long-term prognosis of HOCM has been shown to be similar to that of the general population [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Patients with Hypertrophic Obstructive Cardiomyopathy: A Multicenter Cohort Study with Data-Driven Propensity Score Matching Analysis

He,

Ma,

Sun

et al. 2023

Rev. Cardiovasc. Med.

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Background: Hypertrophic obstructive cardiomyopathy (HOCM) patients are reported to have a potential risk of sudden cardiac death (SCD); however, HCM with left ventricular outflow tract (LVOT) obstruction, which is regarded as a risk indicator of SCD, is doubtful since the LVOT gradient is dynamic and may be confounded by various environmental factors and routine activities. The purpose of this study was to explore the clinical prognosis of HOCM through a multicenter cohort study with data-driven propensity score matching (PSM) analysis. Methods: The cohort included 2268 patients with HCM from 1996 to 2021 in 13 tertiary hospitals. In the present study, we excluded 458 patients who underwent alcohol septal ablation (ASA) and septal myectomy (SM) surgery so 1810 HCM patients were eventually included. We developed a data-driven propensity score using 24 demographic and clinical variables to create 1:1 propensity-matched cohorts. A Cox proportional hazard regression model was constructed to assess the effect of HOCM on mortality. Results: After logit-matching, there were no significant differences in all-cause mortality (log-rank 2 = 1.509, p = 0.22), cardiovascular mortality/cardiac transplantation (log-rank 2 = 0.020, p = 0.89) or SCD (log-rank 2 = 0.503, p = 0.48) between patients with HOCM and hypertrophic nonobstructive cardiomyopathy (HNCM), and according to the Cox proportional hazard regression model, LVOT obstruction was not a risk predictor in patients with HCM. Conclusions: In both matched and unmatched cohorts, there were no significant differences in clinical prognosis between HOCM and HNCM patients, and LVOT obstruction was not an independent risk predictor of prognosis in patients with HCM. Clinical Trial Registration: ChiCTR1800017330.

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“…However, because the evidence is still incomplete and the impact of surgical myectomy debated, lowering the arrhythmic risk in asymptomatic patients is not a primary indication to this intervention. 128 , 129 It is noteworthy that alcohol septal ablation, although it creates a potentially arrhythmic scar, does not appear to increase the risk of SCD. 130 …”

Section: Non-shocking Therapeutic Optionsmentioning

confidence: 99%

Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?

Corrado

Link

Schwartz

2022

European Heart Journal

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Many previously unexplained life-threatening ventricular arrhythmias and sudden cardiac deaths (SCDs) in young individuals are now recognized to be genetic in nature and are ascribed to a growing number of distinct inherited arrhythmogenic diseases. These include hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (VT), and short QT syndrome. Because of their lower frequency compared to coronary disease, risk factors for SCD are not very precise in patients with inherited arrhythmogenic diseases. As randomized studies are generally non-feasible and may even be ethically unjustifiable, especially in the presence of effective therapies, the risk assessment of malignant arrhythmic events such as SCD, cardiac arrest due to ventricular fibrillation (VF), appropriate implantable cardioverter defibrillator (ICD) interventions, or ICD therapy on fast VT/VF to guide ICD implantation is based on observational data and expert consensus. In this document, we review risk factors for SCD and indications for ICD implantation and additional therapies. What emerges is that, allowing for some important differences between cardiomyopathies and channelopathies, there is a growing and disquieting trend to create, and then use, semi-automated systems (risk scores, risk calculators, and, to some extent, even guidelines) which then dictate therapeutic choices. Their common denominator is a tendency to favour ICD implantation, sometime with reason, sometime without it. This contrasts with the time-honoured approach of selecting, among the available therapies, the best option (ICDs included) based on the clinical judgement for the specific patient and after having assessed the protection provided by optimal medical treatment.

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Long-Term Prognosis after Myectomy in Hypertrophic Obstructive Cardiomyopathy with Severe Left Ventricular Hypertrophy

Cited by 4 publications

References 35 publications

Endocardial Radiofrequency Ablation vs. Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

Endocardial Radiofrequency Ablation vs. Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

Prognosis of Patients with Hypertrophic Obstructive Cardiomyopathy: A Multicenter Cohort Study with Data-Driven Propensity Score Matching Analysis

Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice?

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