Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

Yang, Yujun; Fan, Chaomei; Yuan, Jinqing; Qiao, Shubin; Hu, Fenghuan; Guo, Xinfeng; Li, Yishi

doi:10.5603/cj.a2015.0032

Cited by 8 publications

(6 citation statements)

References 29 publications

(57 reference statements)

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“…Similar to our data, a study conducted by Vriesendorp et al (24) reported a 10-year overall survival of 84.0% of MT group, but their study cohort were mildly symptomatic or asymptomatic (NYHA class I/II) patients with HOCM. Our survival rate of MT group was higher compared with two other studies with 10-year overall survival of 75.8% (Ball et (26). This might be due to the fact that these two studies involved some HOCM patients with NYHA class III/IV in the MT group, and multiple studies have demonstrated that for patients with HOCM, NYHA class III/IV is independently associated with worse prognosis (8,27).…”

Section: Discussioncontrasting

confidence: 55%

Midterm Outcome After Septal Myectomy and Medical Therapy in Mildly Symptomatic Patients With Hypertrophic Obstructive Cardiomyopathy

Sun

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThe purpose of this study was mainly to determine the midterm outcome of septal myectomy (SM) and medical therapy (MT) in mildly symptomatic patients (NYHA class II) with hypertrophic obstructive cardiomyopathy (HOCM).MethodsThe study cohort consisted of 184 mildly symptomatic patients with HOCM evaluated in Beijing Anzhen Hospital, Capital Medical University between March 2001 and December 2017, including 82 patients in the SM group and 102 patients in the MT group. Overall survival and HCM-related survival were mainly observed.ResultsThe average follow-up time was 5.0 years. Compared to patients accepting MT, patients treated with SM were associated with comparable overall survival (96.5% and 93.1% vs. 92.9% and 83.0% at 5 and 10 years, respectively; P = 0.197) and HCM-related survival (98.7% and 98.7% vs. 94.2% and 86.1% at 5 and 10 years, respectively; P = 0.063). However, compared to MT, SM was superior at improvement of NYHA class (1.3 ± 0.6 vs. 2.1 ± 0.5, P < 0.001) and mean reduction of resting left ventricular outflow (LVOT) gradient (78.5 ± 18.6% vs. 28.3 ± 18.4%, P < 0.001). Multivariate analysis suggested that resting LVOT gradient in the last clinical examination was an independent predictor of all-cause mortality (HR = 1.017, 95%CI: 1.000–1.034, P = 0.045) and HCM-related mortality (HR = 1.024, 95%CI: 1.005–1.043, P = 0.012) in the entire cohort.ConclusionCompared with MT, SM had comparable overall survival and HCM-related survival in mildly symptomatic HOCM patients, but SM had advantages on improving clinical symptoms and reducing resting LVOT gradient. Resting LVOT gradient in the last clinical examination was an independent predictor of all-cause mortality and HCM-related mortality.

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Section: Discussioncontrasting

confidence: 55%

Midterm Outcome After Septal Myectomy and Medical Therapy in Mildly Symptomatic Patients With Hypertrophic Obstructive Cardiomyopathy

Sun

et al. 2022

Front. Cardiovasc. Med.

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“…Second, Yang et al showed similar results as Ball on survival in the ASA patients (23). Both these studies compared prognostic indicators of these two treatment strategies and demonstrated a superiority of invasive access, respectively ASA, in patients with HOCM.…”

Section: Tab 2 Development Of Parameters In Both Groups (Comparisonsupporting

confidence: 61%

Conservative versus invasive treatment in hypertrophic obstructive cardiomyopathy: an echocardiography study

Honĕk¹,

Krejčí²,

Máchal³

et al. 2017

BLL

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AIM AND METHODS: The aim of our study was to compare the development of echocardiographic parameters and functional status of patients with hypertrophic obstructive cardiomyopathy (HOCM) treated conservatively (n = 41) or by alcohol septal ablation (ASA; n = 39). RESULTS: Left ventricular outfl ow tract gradient (LVOTG) decreased in the fi rst year by 53.7 ± 36.4 mmHg in ASA group versus 5.5±47.1 mmHg in conservatively treated group (p < 0.001), in the third year by 53.1 ± 41.4 mmHg versus 23.9±42.7 mmHg (p = NS) and in the fi fth year, the reduction of LVOTG was 52.1 ± 44.5 mmHg in ASA group and 3.0±63.2 mmHg in conservatively treated group (p < 0.05). Change in NYHA class in the fi rst year was -1.1±0.4 versus 0.1±0.5, in the third year -1.0±0.6 versus 0.1±0.4 and in the fi fth year -0.8 ± 0.5 versus 0.1±0.4 (all p<0.001). CONCLUSION: Our results showed for the fi rst time that decline of LVOTG after ASA creates a favorable left ventricle remodeling and leads to signifi cant improvement of functional status of HOCM patients in comparison with conservative treatment (Tab. 3, Fig. 2, Ref. 42). Text in PDF www.elis.sk.

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“…These anatomic abnormalities include abnormally long MV leaflets (anterior or posterior), bifid PM, and papillary muscle attachment directly to the mitral leaflet base. These anomalies can cause LVOTO even in the absence of septal hypertrophy [ 6 ]. Figure 4 .…”

Section: The Mitral Valvementioning

confidence: 99%

“…Importantly, there is a distinct advantage to invasive management over medical treatment of HOCM patients [ 6 ]. Indeed, more recently, other contributing factors in LVOTO were disclosed: the mitral valve (MV) and its subvalvular apparatus (SVA).…”

Section: Introductionmentioning

confidence: 99%

Review of Contemporary Invasive Treatment Approaches and Critical Appraisal of Guidelines on Hypertrophic Obstructive Cardiomyopathy: State-of-the-Art Review

Lebowitz

Kowalewski

Raffa

et al. 2022

JCM

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Background: Hypertrophic obstructive cardiomyopathy (HOCM) is a heterogeneous disease with different clinical presentations, albeit producing similar dismal long-term outcomes if left untreated. Several approaches are available for the treatment of HOCM; e.g., alcohol septal ablation (ASA) and surgical myectomy (SM). The objectives of the current review were to (1) discuss the place of the standard invasive treatment modalities (ASA and SM) for HOCM; (2) summarize and compare novel techniques for the management of HOCM; (3) analyze current guidelines addressing HOCM management; and (4) offer suggestions for the treatment of complex HOCM presentations. Methods: We searched the literature and attempted to gather the most relevant and impactful available evidence on ASA, SM, and other invasive means of treatment of HOCM. The literature search yielded thousands of results, and 103 significant publications were ultimately included. Results: We critically analyzed available guidelines and provided context in the setting of patient selection for standard and novel treatment modalities. This review offers the most comprehensive analysis to-date of available invasive treatments for HOCM. These include the standard treatments, SM and ASA, as well as novel treatments such as dual-chamber pacing and radiofrequency catheter ablation. We also account for complex pathoanatomic presentations and current guidelines to offer suggestions for tailored care of patients with HOCM. Finally, we consider promising future therapies for HOCM. Conclusions: HOCM is a heterogeneous disease associated with poor outcomes if left untreated. Several strategies for treatment of HOCM are available but patient selection for the procedure is crucial.

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Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

Abstract: 08-0.60; p = 0.003) and maximal septal thickness (HR 1.14; p = 0.011). Conclusions:In patients with severe drug-refractory obstructive HCM, survival after ASA is favorable and better than that of conservative therapy. ASA seems to improve survival. (Cardiol J 2015; 22, 6: 657-664)

Cited by 8 publications

References 29 publications

Midterm Outcome After Septal Myectomy and Medical Therapy in Mildly Symptomatic Patients With Hypertrophic Obstructive Cardiomyopathy

Midterm Outcome After Septal Myectomy and Medical Therapy in Mildly Symptomatic Patients With Hypertrophic Obstructive Cardiomyopathy

Conservative versus invasive treatment in hypertrophic obstructive cardiomyopathy: an echocardiography study

Review of Contemporary Invasive Treatment Approaches and Critical Appraisal of Guidelines on Hypertrophic Obstructive Cardiomyopathy: State-of-the-Art Review

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