Early septal reduction therapy for patients with obstructive hypertrophic cardiomyopathy.

Published on Oct 28, 2020in The Journal of Thoracic and Cardiovascular Surgery4.451
· DOI :10.1016/J.JTCVS.2020.10.062
Hao Cui4
Estimated H-index: 4
(Mayo Clinic),
Hartzell V. Schaff131
Estimated H-index: 131
(Mayo Clinic)
+ 4 AuthorsSteve R. Ommen78
Estimated H-index: 78
(Mayo Clinic)
Sources
Abstract
Abstract Objective This study was conducted to determine the influence of early septal reduction therapy (SRT) after referral on survival in patients with obstructive hypertrophic cardiomyopathy. Methods We reviewed the patients with obstructive hypertrophic cardiomyopathy (resting pressure gradient ≥30 mm Hg or provoked pressure gradient ≥50 mm Hg) who were evaluated at our clinic from 2000 to 2012. Early SRT was defined as undergoing septal myectomy or alcohol septal ablation during the 6 months after index evaluation. Survival after the 6-month landmark period was analyzed in a multivariable Cox model. Results A total of 1351 patients were included in the landmark analysis. Patients who were more symptomatic and had received more medical treatment at index evaluation were more likely to undergo early SRT. Over a median follow-up period of 10.2 years, the survival was comparable (P = .207) but patients undergoing early SRT had, on average, improved survival compared with the medical treatment group (hazard ratio, 0.66; 95% confidence interval, 0.48-0.90) after adjustment by age and comorbidities. Further analysis revealed significant treatment heterogeneity, with increased benefit of early SRT seen in women (hazard ratio, 0.51; 95% confidence interval, 0.35-0.75), those who are in New York Heart Association functional class III or IV (hazard ratio, 0.52; 95% confidence interval, 0.36-0.76), and patients without diabetes (hazard ratio, 0.59; 95% confidence interval, 0.42-0.82). Conclusions In experienced hypertrophic cardiomyopathy centers, early SRT is similar to continued medical treatment for patients with obstructive hypertrophic cardiomyopathy. It appears to improve survival of female patients and those who are in New York Heart Association functional class III or IV.
References24
Newest
#1Carey Kimmelstiel (Tufts Medical Center)H-Index: 24
#2David Zisa (Tufts Medical Center)H-Index: 3
Last. Ethan J. Rowin (Tufts Medical Center)H-Index: 26
view all 12 authors...
Background: The outcome of medically refractory patients with obstructive hypertrophic cardiomyopathy treated according to the American College of Cardiology/American Heart Association consensus gu...
19 CitationsSource
#1Zahara Meghji (Mayo Clinic)H-Index: 4
#2Anita Nguyen (Mayo Clinic)H-Index: 10
Last. Hartzell V. Schaff (Mayo Clinic)H-Index: 131
view all 9 authors...
Importance Recent data indicate that women with hypertrophic cardiomyopathy (HCM) are older and more symptomatic at presentation and have worse clinical outcomes than men. However, to our knowledge, there are no large studies of the association of patient sex with outcomes after surgical myectomy. Objective To analyze preoperative characteristics and overall survival of women and men undergoing septal myectomy for obstructive HCM. Design, Setting, and Participants This retrospective, single-cent...
24 CitationsSource
#1Anita Nguyen (Mayo Clinic)H-Index: 10
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 8 authors...
Abstract Objectives In patients with hypertrophic cardiomyopathy, obstruction of the left ventricular outflow tract can be relieved by surgical septal myectomy or alcohol septal ablation, but uncertainty remains regarding long-term results and comparative effectiveness of alcohol septal ablation. This study aims to compare short- and long-term outcomes of the 2 procedures. Methods Between December 1998 and September 2016, 2407 patients underwent septal myectomy and 211 patients underwent alcohol...
33 CitationsSource
Abstract Background Alcohol-induced infarction for treatment of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) was discussed as a risk factor for increased cardiac mortality during follow-up. Objectives This study sought to report on long-term survival after echo-guided alcohol septal ablation (percutaneous transluminal septal myocardial ablation [PTSMA]) in symptomatic patients with HOCM. Methods Between May 2000 and June 2017, PTSMA with alcohol injection was performed in 952 patie...
37 CitationsSource
#1Martin S. Maron (Tufts Medical Center)H-Index: 70
#2Paolo SpiritoH-Index: 57
Last. Barry J. Maron (Tufts Medical Center)H-Index: 169
view all 3 authors...
6 CitationsSource
#1Anita Nguyen (Mayo Clinic)H-Index: 10
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 7 authors...
Background In patients with hypertrophic cardiomyopathy (HCM), enlargement of the left atrium (LA) is associated with increased morbidity and mortality because of risk of atrial fibrillation (AF), stroke, and heart failure. In this study, we investigated whether LA reverse remodeling occurs after septal myectomy. Methods Between August 2007 and July 2015, 656 patients underwent myectomy at our institution and had preoperative and postoperative transthoracic echocardiographic (TTE) recording of L...
15 CitationsSource
#1Jeffrey B. Geske (Mayo Clinic)H-Index: 25
#2Kevin C. Ong (Mayo Clinic)H-Index: 5
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 12 authors...
Abstract Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. Three thousand six hundred and seventy-three adult patients with HCM underwent evaluation between January 1975 and September 2012 with 1661 (45.2%) female. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of sex with survival. At index visit, women were old...
73 CitationsSource
#1Qun Liu (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 1
#2Diandian Li (Sichuan University)H-Index: 1
Last. Li Gao (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 25
view all 5 authors...
Hypertrophic cardiomyopathy (HCM) is a clinically and genetically heterogeneous disorder but data on survival rates are still conflicting and have not so far been quantitatively reviewed. The aim of this study is to conduct a meta-analysis of cohort studies to assess pooled survival rates and prognostic factors for survival in patients with HCM. Nineteen studies were included representing 12,146 HCM patients. The pooled 1-, 3-, 5- and 10-year survival rates were 98.0%, 94.3%, 82.2% and 75.0%, re...
18 CitationsSource
#1Joon Hwa Hong (Mayo Clinic)H-Index: 3
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 7 authors...
Abstract Background Incidence and outcome of mitral valve (MV) surgery are unknown in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing extended transaortic septal myectomy. Objectives This study sought to define indications and suitable operative strategy for mitral regurgitation (MR) in patients with HOCM. Methods A total of 2,107 septal myectomy operations performed in adults from January 1993 to May 2014 at Mayo Clinic in Rochester, Minnesota, were retrospectively revie...
91 CitationsSource
#1Kevin C. OngH-Index: 5
#2Jeffrey B. GeskeH-Index: 25
Last. Bernard J. GershH-Index: 163
view all 12 authors...
Aims Pulmonary hypertension (PH) is associated with increased mortality in various forms of left-sided heart disease. However, the implications of PH in hypertrophic cardiomyopathy (HCM) have not been elucidated. The objective of this study was to determine the prevalence and prognostic implications of PH in HCM. Methods and results The study cohort consisted of 1570 (54 ± 15 years; 53% male) adults with HCM followed for a median of 3.3 years. PH [pulmonary artery systolic pressure (PASP) >36 mm...
35 CitationsSource
Cited By4
Newest
#1Stephanie Nguyen (CUMC: Columbia University Medical Center)H-Index: 5
#2Shepard D. Weiner (CUMC: Columbia University Medical Center)H-Index: 7
Last. Hiroo TakayamaH-Index: 58
view all 4 authors...
Source
Source
#1Amine Mazine (Sunnybrook Health Sciences Centre)H-Index: 1
#2Derrick Y. TamH-Index: 19
Last. Stephen E. FremesH-Index: 71
view all 3 authors...
Source
#1Stephanie N. Nguyen (UCI: University of California, Irvine)
#2Yuichi J. Shimada (UCI: University of California, Irvine)
Last. Hiroo Takayama (UCI: University of California, Irvine)H-Index: 1
view all 4 authors...
Source