Published Online
on February 16, 2004

A more recent version of this article appeared on February 24, 2004

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Submitted on October 24, 2003
Revised on December 19, 2003
Accepted on December 30, 2003

Predictors of Outcome After Alcohol Septal Ablation Therapy in Patients With Hypertrophic Obstructive Cardiomyopathy

Su Min Chang MD, Nasser M. Lakkis MD, Jennifer Franklin RN, William H. Spencer III MD, and Sherif F. Nagueh MD^*

From the Department of Medicine (S.M.C.), Section of Cardiovascular Medicine, University of Wisconsin, Madison; and Department of Medicine (N.M.L., J.F., W.H.S., S.F.N.), Section of Cardiology, Baylor College of Medicine, Houston, Tex.

^* To whom correspondence should be addressed. E-mail: sherifn{at}bcm.tmc.edu.

Background--Alcohol septal ablation (ASA) therapy results in clinical and hemodynamic improvement in patients with hypertrophic obstructive cardiomyopathy. However, a subset remains symptomatic afterward, requiring additional procedures. We sought to examine the determinants of an unsatisfactory outcome, defined as unchanged symptoms with <50% reduction of baseline left ventricular outflow tract (LVOT) gradient.

Methods and Results--Of 173 consecutive hypertrophic obstructive cardiomyopathy patients who underwent ASA, 39 had an unsatisfactory outcome after the first procedure. Patients with an unsatisfactory outcome had a higher baseline LVOT gradient, fewer septal arteries injected with ethanol, lower peak creatine kinase (CK), smaller septal area opacified by contrast echocardiography, and higher residual gradient in the catheterization laboratory after ASA (all P<0.05). Symptoms, septal thickness, mitral regurgitation severity, and ventricular function were not determinants of outcome. On multiple logistic regression, LVOT gradient reduction after ASA in the catheterization laboratory to 25 mm Hg (OR, 5.5; P=0.01) and peak CK <1300 U/L (OR, 2.5; P=0.04) were the independent predictors of an unsatisfactory outcome.

Conclusions--The residual LVOT gradient in the catheterization laboratory and peak CK leak after ASA are the independent predictors of ASA outcome.

Key words: ablation • cardiomyopathy • hypertrophy • alcohol

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