Predictors of an optimal clinical outcome with alcohol septal ablation for obstructive hypertrophic cardiomyopathy

Authors

  • Paul Sorajja MD,

    Corresponding author
    1. Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
    • Associate Professor of Medicine, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 1st Street SW Rochester, MN 55905
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    • Dr. Sorajja and Dr. Binder contributed equally to production of this study.

  • Josepha Binder MD,

    1. Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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  • Rick A. Nishimura MD,

    1. Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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  • David R. Holmes Jr. MD,

    1. Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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  • Charanjit S. Rihal MD,

    1. Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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  • Bernard J. Gersh MD,

    1. Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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  • John F. Bresnahan MD,

    1. Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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  • Steve R. Ommen MD

    1. Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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  • Conflict of Interest: None.

Abstract

Background

Alcohol septal ablation has emerged as a therapy for patients with obstructive hypertrophic cardiomyopathy (HCM). However, there are limited data on the predictors of success with the procedure.

Methods

We examined patient characteristics and cardiac morphology as well as procedural data on 166 HCM patients (mean age, 63 years; 43% men), who underwent ablation at Mayo Clinic. Patients were contacted to determine vital status and symptoms to assess the primary endpoint of survival free of death and severe symptoms (New York Heart Association, class III or IV dyspnea).

Results

The strongest patient characteristics that predicted clinical success were older age, less severe left ventricular outflow tract gradient, lesser ventricular septal hypertrophy, and a smaller left anterior descending (LAD) diameter. Mitral valve geometry or ventricular septal morphology did not predict outcome. Patients with ≥3 characteristics (age ≥65 years, gradient <100 mmHg, septal hypertrophy ≤18 mm, LAD diameter <4.0 mm) had superior 4-year survival free of death and severe symptoms (90.4%) in comparison to those with two characteristics (81.6%) and ≤1 characteristic (57.5%). Case volume with >50 patients was an independent predictor of survival free of severe symptoms. The volume of alcohol injected, number of arteries injected, or size of septal perforator artery were not predictive of clinical success.

Conclusions

Greater case volume and selection for key patient and anatomic characteristics are associated with superior outcomes with alcohol septal ablation. © 2012 Wiley Periodicals, Inc.

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