Abstract 15448: Both Aggressive Ablation and Volume Management Reduce the Need for Repeat Alcohol Septal Ablations in Patients With Hypertrophic Cardiomyopathy
Alcohol septal ablation (ASA) has been shown to improve symptoms in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction. Repeat ASA is occasionally necessary in patients with recurrent symptoms and gradients. We assessed the hypothesis that both medical management and aggressive ablation would reduce the need for repeat ASA.
We evaluated 339 patients who underwent one or more ASA procedures and were available for one-year clinical follow-up. Baseline characteristics, background medical therapy and procedural data were analyzed. Patients who underwent one procedure (n=296) were compared to those who underwent repeat ASA (n=43).
In univariate analysis, patients requiring repeat ASA had higher angina class (p=0.019), higher post LVOT gradient by echo (p=0.005), lower peak CK (p=0.011), and less diuretic use at baseline (p=0.014) and at 3 months post procedure (p=0.0043). In the multivariable logistic regression model that controlled for angina class, diuretic use, peak CK and post-LVOT gradient by echo; each 100 unit increase in peak CK, in comparing any two patients, resulted in a 9% decrease in the odds of requiring 2 or more ASAs (OR = 0.91, 95% CI 0.83-0.99, p = 0.022). For every 1 mmHg residual post LVOTG, in comparison of any two patients, there is a 4% increase in requiring two or more ASAs (95% CI 1.01-1.07, p = 0.012). Subjects not on diuretics at baseline were 3.2 times more likely to require more than one ASA (95% CI 1.2-8.6, p = 0.022), and there was no association with any specific type of diuretic. The odds of requiring more than one ASA for subjects not on diuretics at 3 months were 2.6 times the odds of requiring more than one ASA for subjects taking diuretics at baseline controlling for peak CK and post-LVOTG echo (95% CI 0.89-7.52, p = 0.080).
In conclusion, our data show that aggressive ASA and aggressive medical therapy with volume management result in significant reductions in the need for clinically driven repeat ASA.
- © 2013 by American Heart Association, Inc.