One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response
The aim of this study was to analyze hemodynamic and clinical outcome in a cohort of 312 patients who were followed up over a period of 12 months after alcohol septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). PTSMA was intended in 337 patients with HOCM (mean a...
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| Veröffentlicht in: | Clinical research in cardiology 2007-12, Vol.96 (12), p.864-873 |
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| creator | Faber, L Welge, D Fassbender, D Schmidt, H K Horstkotte, D Seggewiss, H |
| description | The aim of this study was to analyze hemodynamic and clinical outcome in a cohort of 312 patients who were followed up over a period of 12 months after alcohol septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
PTSMA was intended in 337 patients with HOCM (mean age: 54+/-15 years), with 312 procedures completed by injection of 2.8+/-1.2 ml of alcohol. In 25 patients (8%) the intervention was aborted, mostly because of contrast echocardiographic findings. In the 312 patients who received alcohol, permanent pacing was necessary in 22 cases (7%); and in-hospital mortality was 1.3% (four patients). During follow-up, contact to six patients (2%) was lost, and three additional patients (1%) died. The 299 patients who either underwent non-invasive reassessment in our institution or transmitted followup data from their local physician formed the study population. Improvement in symptoms was reported by 272 patients (91%). Mean NYHA functional class was reduced from 2.9+/-0.4 to 1.5+/-0.7 (p |
| doi_str_mv | 10.1007/s00392-007-0578-9 |
| format | Article |
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PTSMA was intended in 337 patients with HOCM (mean age: 54+/-15 years), with 312 procedures completed by injection of 2.8+/-1.2 ml of alcohol. In 25 patients (8%) the intervention was aborted, mostly because of contrast echocardiographic findings. In the 312 patients who received alcohol, permanent pacing was necessary in 22 cases (7%); and in-hospital mortality was 1.3% (four patients). During follow-up, contact to six patients (2%) was lost, and three additional patients (1%) died. The 299 patients who either underwent non-invasive reassessment in our institution or transmitted followup data from their local physician formed the study population. Improvement in symptoms was reported by 272 patients (91%). Mean NYHA functional class was reduced from 2.9+/-0.4 to 1.5+/-0.7 (p<0.0001) along with a gradient reduction (echo-Doppler) from 59+/-32 to 8+/-15 mmHg at rest, and from 120+/-42 to 28+/-32 mmHg with provocation (p<0.0001 each). Exercise capacity improved from 94+/-51 to 119+/-40 watts (p=0.001), and peak oxygen consumption from 18+/-4 to 21+/-6 ml/ kg/min (p=0.01). Younger age and higher outflow gradients at baseline and immediately after intervention were associated with a less favorable hemodynamic outcome. The degree of limitation of exercise capacity at baseline was the only predictor of symptomatic improvement.
Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. In contrast to a previous study, in this cohort of 312 patients there was no association between post-interventional enzyme release and hemodynamic success. Younger patients with high baseline gradients, however, tended to have a less favorable hemodynamic outcome with higher residual gradients.</description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-007-0578-9</identifier><identifier>PMID: 17891518</identifier><language>eng</language><publisher>Germany: Springer Nature B.V</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cardiomyopathy, Hypertrophic - diagnostic imaging ; Cardiomyopathy, Hypertrophic - drug therapy ; Cardiomyopathy, Hypertrophic - physiopathology ; Chi-Square Distribution ; Echocardiography ; Ethanol - therapeutic use ; Female ; Follow-Up Studies ; Heart Septum - drug effects ; Heart Septum - physiopathology ; Hemodynamics ; Humans ; Logistic Models ; Male ; Middle Aged ; Solvents - therapeutic use ; Survival Analysis ; Treatment Outcome ; Ventricular Outflow Obstruction - diagnostic imaging ; Ventricular Outflow Obstruction - drug therapy ; Ventricular Outflow Obstruction - physiopathology</subject><ispartof>Clinical research in cardiology, 2007-12, Vol.96 (12), p.864-873</ispartof><rights>Steinkopff-Verlag 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c392t-9d8bd721e758090b92095f0570087546580011bf46865e6d0d5bac7db297f7d3</citedby><cites>FETCH-LOGICAL-c392t-9d8bd721e758090b92095f0570087546580011bf46865e6d0d5bac7db297f7d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17891518$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Faber, L</creatorcontrib><creatorcontrib>Welge, D</creatorcontrib><creatorcontrib>Fassbender, D</creatorcontrib><creatorcontrib>Schmidt, H K</creatorcontrib><creatorcontrib>Horstkotte, D</creatorcontrib><creatorcontrib>Seggewiss, H</creatorcontrib><title>One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><description>The aim of this study was to analyze hemodynamic and clinical outcome in a cohort of 312 patients who were followed up over a period of 12 months after alcohol septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
PTSMA was intended in 337 patients with HOCM (mean age: 54+/-15 years), with 312 procedures completed by injection of 2.8+/-1.2 ml of alcohol. In 25 patients (8%) the intervention was aborted, mostly because of contrast echocardiographic findings. In the 312 patients who received alcohol, permanent pacing was necessary in 22 cases (7%); and in-hospital mortality was 1.3% (four patients). During follow-up, contact to six patients (2%) was lost, and three additional patients (1%) died. The 299 patients who either underwent non-invasive reassessment in our institution or transmitted followup data from their local physician formed the study population. Improvement in symptoms was reported by 272 patients (91%). Mean NYHA functional class was reduced from 2.9+/-0.4 to 1.5+/-0.7 (p<0.0001) along with a gradient reduction (echo-Doppler) from 59+/-32 to 8+/-15 mmHg at rest, and from 120+/-42 to 28+/-32 mmHg with provocation (p<0.0001 each). Exercise capacity improved from 94+/-51 to 119+/-40 watts (p=0.001), and peak oxygen consumption from 18+/-4 to 21+/-6 ml/ kg/min (p=0.01). Younger age and higher outflow gradients at baseline and immediately after intervention were associated with a less favorable hemodynamic outcome. The degree of limitation of exercise capacity at baseline was the only predictor of symptomatic improvement.
Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. In contrast to a previous study, in this cohort of 312 patients there was no association between post-interventional enzyme release and hemodynamic success. Younger patients with high baseline gradients, however, tended to have a less favorable hemodynamic outcome with higher residual gradients.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiomyopathy, Hypertrophic - diagnostic imaging</subject><subject>Cardiomyopathy, Hypertrophic - drug therapy</subject><subject>Cardiomyopathy, Hypertrophic - physiopathology</subject><subject>Chi-Square Distribution</subject><subject>Echocardiography</subject><subject>Ethanol - therapeutic use</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Septum - drug effects</subject><subject>Heart Septum - physiopathology</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Solvents - therapeutic use</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Ventricular Outflow Obstruction - diagnostic imaging</subject><subject>Ventricular Outflow Obstruction - drug therapy</subject><subject>Ventricular Outflow Obstruction - physiopathology</subject><issn>1861-0684</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkcFuFSEUhonRtLX2AdwY4qI79DAzDODONFZNmnTTPWGAyaWZAQRGM8_kS8rNvdHEFeecfOc_5P8RekvhAwXgHwtALzvSSgKMCyJfoCsqRkpglN3Lv7UYLtHrUp4BGIV-uECXlAtJGRVX6PdjcGR3OuM5Lkv8RbaE44yTy2arOri4FVxcqnrBelp09TE0MuOyr6nGtQ0MPuwNrzmmQ2viVGreTPU_HTY6Wx_XPSZdDzv2Afe0w63xLtTyCafsrDc15nK8eXBrtHvQa1PRwWKz-OBNO5xdSTEU9wa9mvVS3M35vUZP91-e7r6Rh8ev3-8-PxDT3KhEWjFZ3lHHmQAJk-xAsrkZBCA4G8Y2BUqneRjFyNxowbJJG26nTvKZ2_4a3Z5kU44_NleqWn0xbllOdqhRNBEQrIHv_wOf45ZD-5oSgsHQvBYNoifI5FhKdrNK2a8674qCOqaoTimqY3lMUcm28-4svE2rs_82zrH1fwBYU5ur</recordid><startdate>20071201</startdate><enddate>20071201</enddate><creator>Faber, L</creator><creator>Welge, D</creator><creator>Fassbender, D</creator><creator>Schmidt, H K</creator><creator>Horstkotte, D</creator><creator>Seggewiss, H</creator><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20071201</creationdate><title>One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response</title><author>Faber, L ; Welge, D ; Fassbender, D ; Schmidt, H K ; Horstkotte, D ; Seggewiss, H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c392t-9d8bd721e758090b92095f0570087546580011bf46865e6d0d5bac7db297f7d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiomyopathy, Hypertrophic - diagnostic imaging</topic><topic>Cardiomyopathy, Hypertrophic - drug therapy</topic><topic>Cardiomyopathy, Hypertrophic - physiopathology</topic><topic>Chi-Square Distribution</topic><topic>Echocardiography</topic><topic>Ethanol - therapeutic use</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Septum - drug effects</topic><topic>Heart Septum - physiopathology</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Solvents - therapeutic use</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Ventricular Outflow Obstruction - diagnostic imaging</topic><topic>Ventricular Outflow Obstruction - drug therapy</topic><topic>Ventricular Outflow Obstruction - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Faber, L</creatorcontrib><creatorcontrib>Welge, D</creatorcontrib><creatorcontrib>Fassbender, D</creatorcontrib><creatorcontrib>Schmidt, H K</creatorcontrib><creatorcontrib>Horstkotte, D</creatorcontrib><creatorcontrib>Seggewiss, H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Faber, L</au><au>Welge, D</au><au>Fassbender, D</au><au>Schmidt, H K</au><au>Horstkotte, D</au><au>Seggewiss, H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response</atitle><jtitle>Clinical research in cardiology</jtitle><addtitle>Clin Res Cardiol</addtitle><date>2007-12-01</date><risdate>2007</risdate><volume>96</volume><issue>12</issue><spage>864</spage><epage>873</epage><pages>864-873</pages><issn>1861-0684</issn><eissn>1861-0692</eissn><abstract>The aim of this study was to analyze hemodynamic and clinical outcome in a cohort of 312 patients who were followed up over a period of 12 months after alcohol septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
PTSMA was intended in 337 patients with HOCM (mean age: 54+/-15 years), with 312 procedures completed by injection of 2.8+/-1.2 ml of alcohol. In 25 patients (8%) the intervention was aborted, mostly because of contrast echocardiographic findings. In the 312 patients who received alcohol, permanent pacing was necessary in 22 cases (7%); and in-hospital mortality was 1.3% (four patients). During follow-up, contact to six patients (2%) was lost, and three additional patients (1%) died. The 299 patients who either underwent non-invasive reassessment in our institution or transmitted followup data from their local physician formed the study population. Improvement in symptoms was reported by 272 patients (91%). Mean NYHA functional class was reduced from 2.9+/-0.4 to 1.5+/-0.7 (p<0.0001) along with a gradient reduction (echo-Doppler) from 59+/-32 to 8+/-15 mmHg at rest, and from 120+/-42 to 28+/-32 mmHg with provocation (p<0.0001 each). Exercise capacity improved from 94+/-51 to 119+/-40 watts (p=0.001), and peak oxygen consumption from 18+/-4 to 21+/-6 ml/ kg/min (p=0.01). Younger age and higher outflow gradients at baseline and immediately after intervention were associated with a less favorable hemodynamic outcome. The degree of limitation of exercise capacity at baseline was the only predictor of symptomatic improvement.
Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. In contrast to a previous study, in this cohort of 312 patients there was no association between post-interventional enzyme release and hemodynamic success. Younger patients with high baseline gradients, however, tended to have a less favorable hemodynamic outcome with higher residual gradients.</abstract><cop>Germany</cop><pub>Springer Nature B.V</pub><pmid>17891518</pmid><doi>10.1007/s00392-007-0578-9</doi><tpages>10</tpages></addata></record> |
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| ispartof | Clinical research in cardiology, 2007-12, Vol.96 (12), p.864-873 |
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| subjects | Adolescent Adult Aged Aged, 80 and over Cardiomyopathy, Hypertrophic - diagnostic imaging Cardiomyopathy, Hypertrophic - drug therapy Cardiomyopathy, Hypertrophic - physiopathology Chi-Square Distribution Echocardiography Ethanol - therapeutic use Female Follow-Up Studies Heart Septum - drug effects Heart Septum - physiopathology Hemodynamics Humans Logistic Models Male Middle Aged Solvents - therapeutic use Survival Analysis Treatment Outcome Ventricular Outflow Obstruction - diagnostic imaging Ventricular Outflow Obstruction - drug therapy Ventricular Outflow Obstruction - physiopathology |
| title | One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response |
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