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Predictors of outcome after alcohol septal ablation therapy in patients with hypertrophic obstructive cardiomyopathy.
- Source :
-
Circulation [Circulation] 2004 Feb 24; Vol. 109 (7), pp. 824-7. Date of Electronic Publication: 2004 Feb 16. - Publication Year :
- 2004
-
Abstract
- 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.<br />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 > or =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.<br />Conclusions: The residual LVOT gradient in the catheterization laboratory and peak CK leak after ASA are the independent predictors of ASA outcome.
- Subjects :
- Adult
Aged
Angina Pectoris etiology
Cardiac Catheterization
Cardiomyopathy, Hypertrophic complications
Cardiomyopathy, Hypertrophic, Familial complications
Cardiomyopathy, Hypertrophic, Familial therapy
Dyspnea etiology
Exercise Tolerance
Female
Heart Failure etiology
Heart Septum pathology
Humans
Male
Middle Aged
Mitral Valve Insufficiency complications
Sex Factors
Treatment Outcome
Ventricular Outflow Obstruction etiology
Cardiomyopathy, Hypertrophic therapy
Ethanol therapeutic use
Heart Septum drug effects
Sclerosing Solutions therapeutic use
Sclerotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4539
- Volume :
- 109
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 14967729
- Full Text :
- https://doi.org/10.1161/01.CIR.0000117089.99918.5A