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Risk marker profiles in patients treated with percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy

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Abstract

Background and study objective

Different studies have shown a good long-term survival with improvement of symptoms and hemodynamics after percutaneous septal ablation (PTSMA), similar to myectomy considered to be the therapeutic “gold standard” for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Furthermore, desobliteration of left ventricular (LV) outflow may modify features of the disease considered to be risk-relevant, such as magnitude of LV hypertrophy, outflow gradient, and left atrial (LA) size. The aim oft this study was to examine predictors of long-term mortality in a large cohort of patients with HOCM treated with PTSMA.

Methods and results

497 consecutive patients with symptomatic HOCM (mean age 55.4 ± 14.4 years, NYHA class: 2.9 ± 0.4) who underwent PTSMA between 1996 and 2014 were studied. Periprocedural mortality was 1% (five patients). During a follow-up time of 64.5 ± 53.2 months (range 0.1–207), 51 patients died, of these 25 due to cardiovascular problems, while 26 deaths were attributed to non-cardiac causes. Overall survival rates were 89.4% (± 1.7) after 5 and 80.6% (± 2.7) after 10 years. Among the baseline variables, advanced age, recurrent syncope, and magnitude of LV thickening were risk markers correlated to long-term post-procedural survival. The only mortality predictor that could be identified during follow-up was post-procedural NYHA class. Neither the other classical HCM risk markers nor other clinical or echocardiographic parameters predicted cardiac or all-cause mortality in this cohort.

Conclusions

Our findings suggest that the risk profile after septal ablation may differ from that of HOCM patients without an outflow desobliteration.

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Abbreviations

AV:

Atrioventricular

CCS:

Canadian Cardiovascular Society

CK:

Creatine Kinase

CW:

Continuous wave Doppler

EKG:

Electrocardiogram

ESC:

European Society of Cardiology

FS:

Fractional shortening

H(O/N)CM:

Hypertrophic (obstructive/non-obstructive) cardiomyopathy

HR:

Hazard ratio

ICD:

Implantable cardioverter defibrillator

IVS:

Intraventricular septum

LA:

Left atrium

LAD:

Left anterior descending artery

LV:

Left ventricle

LVEDD:

Left ventricular end-diastolic diameter

LVOT:

Left ventricular outflow tract

LVOTG:

Left ventricular outflow tract gradient

LVOTO:

Left ventricular outflow tract obstruction

MRI:

Magnetic resonance imaging

nsVT:

Non-sustained ventricular tachycardia

NYHA:

New York Heart Association

PTSMA:

Percutaneous transluminal septal myocardial ablation

SAM:

Systolic anterior movement of the mitral valve

SCD:

Sudden cardiac death

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Acknowledgements

All authors have participated in the work and agree with the content of the article which contains data from the MD thesis of A. B. Parts of this work have been presented as abstract during the Annual Meeting of the German Cardiac Society 2015.

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Authors and Affiliations

  1. Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany

    Amelie Burghardt, Frank van Buuren, Zisis Dimitriadis, Tim Grübbel, Hubert Seggewiss, Smita Scholtz, Dieter Horstkotte & Lothar Faber

  2. Medical Clinic I, Leopoldina Hospital, Schweinfurt, Germany

    Hubert Seggewiss

Authors
  1. Amelie Burghardt
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  2. Frank van Buuren
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  3. Zisis Dimitriadis
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  4. Tim Grübbel
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  8. Lothar Faber
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Correspondence to Lothar Faber.

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Ethical standards

The study protocol was approved by the institutional review board (Ref.-#: 14/2014) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Burghardt, A., van Buuren, F., Dimitriadis, Z. et al. Risk marker profiles in patients treated with percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy. Clin Res Cardiol 107, 479–486 (2018). https://doi.org/10.1007/s00392-018-1209-3

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  • DOI: https://doi.org/10.1007/s00392-018-1209-3

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