Abstract 19001: Clinical Predictors for Repeat Alcohol Septal Ablation in Refractory Hypertrophic Obstructive Cardiomyopathy
Background: Alcohol septal ablation (ASA) attenuates the intraventricular obstruction in drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). The result, however, has been inconsistent in each individual, and considerable patients need repeat septal reduction therapy. Therefore, we have pursued the clinical predictors for repeat ASA.
Methods: We investigated consecutive 154 patients who received ASA. There were 32 patients (Group R) needed repeat ASA and 122 patients without repeat ASA (Group S). We also performed morphologic analysis by cardiac magnetic resonance (CMR) (n=98).
Results: In comparison with group S, group R was younger (56+/-16years vs 64+/-13years, p=0.006), higher in presence of combined outflow tract (OT) and mid-ventricle (MV) obstruction (44% vs 19%, p=0.003), thicker of interventricular septum (19.6+/-4.1mm vs 17.9+/-3.9mm, p=0.034) and lower in peak CPK (900+/-421U/l vs 1269+/-549U/l, p<0.001). In multiple logistic regression model, combined obstruction (adjusted odds ratio 4.298 [95%CI: 1.661~11.12], p=0.003) and peak CPK (0.814 [95%CI: 0.722~0.919] per 100U/L, p=0.001) were independent predictors. Percentages of repeat ASA were 17%, 6% and 38% in those with OT, MV and combined obstruction, respectively (p=0.008). CMR study displayed that group R had the similar hypertrophy of anteroseptal region (20.3+/-4.6mm vs 19.1+/-4.4mm, p=0.379), meanwhile at the basal left ventricular level, the thickness of posteroseptal (18.4+/-4.2mm vs 15.9+/-4.2mm, p=0.014), anterolateral (12.2+/-4.8mm vs 9.6+/-2.3mm, p=0.025) and posterolateral (11.0+/-3.7mm vs 8.7+/-2.0mm, p=0.006) regions were significantly higher than group S. After 2nd ASA, New York Heart Association functional class improved from 2.3+/-0.7 to 1.2+/-0.4 at 1-year follow-up, and there were 2 cases underwent 3rd ASA and 1 sudden death during the follow-up period (6.2 [IQR 2.0~11] years).
Conclusions: Combined obstruction and peak CPK after 1st ASA were independent predictors for repeat ASA. The present study demonstrated the favorable results of 2nd ASA, therefore staged ablation is reasonable strategy for combined obstruction.
Author Disclosures: M. Kitamura: None. M. Takayama: None. Y. Amano: None. J. Shibuya: None. J. Matsuda: None. A. Yoshinaga: None. S. Nakamura: None. K. Asai: None. H. Takano: None. W. Shimizu: None.
- © 2014 by American Heart Association, Inc.