Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry

Josef Veselka; Morten Kvistholm Jensen; Max Liebregts; Jaroslav Januska; Jan Krejci; Thomas Bartel; Maciej Dabrowski; Peter Riis Hansen; Vibeke Marie Almaas; Hubert Seggewiss; Dieter Horstkotte; Pavol Tomasov; Radka Adlova; Henning Bundgaard; Robbert Steggerda; Jurriën Ten Berg; Lothar Faber

doi:10.1093/eurheartj/ehv693

Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry

Josef Veselka, Morten Kvistholm Jensen, Max Liebregts, Jaroslav Januska, Jan Krejci, Thomas Bartel, Maciej Dabrowski, Peter Riis Hansen, Vibeke Marie Almaas, Hubert Seggewiss, Dieter Horstkotte, Pavol Tomasov, Radka Adlova, Henning Bundgaard, Robbert Steggerda, Jurriën Ten Berg, Lothar Faber

Institut for Klinisk Medicin

83 Citationer (Scopus)

Abstract

Aims The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. Methods and results We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 ± 36 to 16 ± 21 mmHg (P < 0.01) and NYHA class from 2.9 ± 0.5 to 1.6 ± 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class ≤2, which was independently associated with LV outflow tract gradient (P < 0.01). Conclusions The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient.

Originalsprog	Engelsk
Tidsskrift	European Heart Journal
Vol/bind	37
Udgave nummer	19
Sider (fra-til)	1517-23
Antal sider	7
ISSN	0195-668X
DOI	https://doi.org/10.1093/eurheartj/ehv693
Status	Udgivet - 14 maj 2016

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Veselka, J., Jensen, M. K., Liebregts, M., Januska, J., Krejci, J., Bartel, T., Dabrowski, M., Hansen, P. R., Almaas, V. M., Seggewiss, H., Horstkotte, D., Tomasov, P., Adlova, R., Bundgaard, H., Steggerda, R., Ten Berg, J., & Faber, L. (2016). Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry. European Heart Journal, 37(19), 1517-23. https://doi.org/10.1093/eurheartj/ehv693

Veselka, J, Jensen, MK, Liebregts, M, Januska, J, Krejci, J, Bartel, T, Dabrowski, M, Hansen, PR, Almaas, VM, Seggewiss, H, Horstkotte, D, Tomasov, P, Adlova, R, Bundgaard, H, Steggerda, R, Ten Berg, J & Faber, L 2016, 'Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry', European Heart Journal, bind 37, nr. 19, s. 1517-23. https://doi.org/10.1093/eurheartj/ehv693

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abstract = "Aims The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. Methods and results We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 ± 36 to 16 ± 21 mmHg (P < 0.01) and NYHA class from 2.9 ± 0.5 to 1.6 ± 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class ≤2, which was independently associated with LV outflow tract gradient (P < 0.01). Conclusions The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient.",

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author = "Josef Veselka and Jensen, {Morten Kvistholm} and Max Liebregts and Jaroslav Januska and Jan Krejci and Thomas Bartel and Maciej Dabrowski and Hansen, {Peter Riis} and Almaas, {Vibeke Marie} and Hubert Seggewiss and Dieter Horstkotte and Pavol Tomasov and Radka Adlova and Henning Bundgaard and Robbert Steggerda and {Ten Berg}, Jurri{\"e}n and Lothar Faber",

year = "2016",

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doi = "10.1093/eurheartj/ehv693",

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volume = "37",

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TY - JOUR

T1 - Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

T2 - results from the Euro-ASA registry

AU - Veselka, Josef

AU - Jensen, Morten Kvistholm

AU - Liebregts, Max

AU - Januska, Jaroslav

AU - Krejci, Jan

AU - Bartel, Thomas

AU - Dabrowski, Maciej

AU - Hansen, Peter Riis

AU - Almaas, Vibeke Marie

AU - Seggewiss, Hubert

AU - Horstkotte, Dieter

AU - Tomasov, Pavol

AU - Adlova, Radka

AU - Bundgaard, Henning

AU - Steggerda, Robbert

AU - Ten Berg, Jurriën

AU - Faber, Lothar

PY - 2016/5/14

Y1 - 2016/5/14

N2 - Aims The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. Methods and results We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 ± 36 to 16 ± 21 mmHg (P < 0.01) and NYHA class from 2.9 ± 0.5 to 1.6 ± 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class ≤2, which was independently associated with LV outflow tract gradient (P < 0.01). Conclusions The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient.

AB - Aims The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. Methods and results We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 ± 36 to 16 ± 21 mmHg (P < 0.01) and NYHA class from 2.9 ± 0.5 to 1.6 ± 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class ≤2, which was independently associated with LV outflow tract gradient (P < 0.01). Conclusions The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient.

KW - Journal Article

U2 - 10.1093/eurheartj/ehv693

DO - 10.1093/eurheartj/ehv693

M3 - Journal article

C2 - 26746632

SN - 0195-668X

VL - 37

SP - 1517

EP - 1523

JO - European Heart Journal

JF - European Heart Journal

IS - 19

ER -

Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry

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