TY - JOUR
T1 - Predictors of Outcome after Alcohol Septal Ablation Therapy in Patients with Hypertrophic Obstructive Cardiomyopathy
AU - Chang, Su-Min
AU - Lakkis, Nasser M.
AU - Franklin, Jennifer
AU - Spencer, William H.
AU - Nagueh, Sherif
PY - 2004/2/24
Y1 - 2004/2/24
N2 - 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.
AB - 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.
KW - Ablation
KW - Alcohol
KW - Cardiomyopathy
KW - Hypertrophy
UR - http://www.scopus.com/inward/record.url?scp=1342288505&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=1342288505&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.0000117089.99918.5A
DO - 10.1161/01.CIR.0000117089.99918.5A
M3 - Article
C2 - 14967729
AN - SCOPUS:1342288505
VL - 109
SP - 824
EP - 827
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 7
ER -