ABSTRACT
Objective: To evaluate the long-term outcome of patients with hypertrophic obstructive cardiomyopathy(HOCM) after percutaneous transluminal septal ablation(PTSMA). Methods: HOCM patients who underwent PTSMA and surgical myectomy at the Chest Hospital of Shanghai Jiao Tong University from April 2001 to February 2019 were included in this retrospective analysis. Patients were divided into PTSMA group and surgical myectomy group. In addition, patients undergoing PTSMA were further divided into HOCM-PTSMA non-survivor group and HOCM-PTSMA survivor group. The general clinical information, procedural/surgical information and complications during hospitalization were compared between groups. Multivariate Cox regression model was used to analyze the independent risk factors for all-cause death in HOCM patients after PTSMA. Results: A total of 104 patients with HOCM who underwent PTSMA were enrolled. Mean age of the patients was (54±15) years old, including 41 females (38.7%). The follow-up time was 37.5(14.3, 76.8) months. At the last follow-up, 12 patients died (HOCM-PTSMA non-survivor group) and 92 were alive(HOCM-PTSMA survivor group). The proportion of patients with NYHA function class Ⅲ/Ⅳ was higher(P=0.036), and the posterior wall of the left ventricle was thicker(P=0.006) in the HOCM-PTSMA non-survivor group than in the HOCM-PTSMA survivor group. The immediate success rate of PTSMA in this cohort was 66%(70/104). The amount of absolute alcohol during the operation in the HOCM-PTSMA non-survivor group was (2.9±0.8) ml, which tended to be higher as compared to that in the HOCM-PTSMA survivor group((2.4±1.0)ml, P=0.056). Kaplan-Meier survival curve analysis showed that patients with HOCM who underwent PTSMA had an all-cause mortality-free survival rate of 90.1%, 78.3%, and 56.9% at 5, 10 and 15 years, and a HOCM-free survival rate of 91.3%, 79.4% and 57.7% at 5, 10 and 15 years, respectively. Multivariate Cox regression analysis showed that age≥ 65 years was an independent risk factor for all-cause death after PTSMA in patients with HOCM (HR=2.697, 95%CI 1.292-18.977, P=0.020). There were 32 patients in the surgical myectomy group. The proportion of patients with NYHA function class Ⅲ/Ⅳ was higher than that in the PTSMA group(P<0.001), while age, gender, and major comorbidities(atrial fibrillation, coronary heart disease, hypertension, and diabetes) as well as the left atrium dimension were all similar between the two groups(all P>0.05). Patients in the surgical myectomy group were followed up for 38.0(17.6, 64.2)months, and no deaths occurred during the follow-up period. Kaplan-Meier survival curve analysis showed that there were no statistically significant differences in all-cause-free and HOCM-free survival rates between patients in PTSMA group and surgical myectomy group(P=0.089 and 0.110, respectively). Conclusion: PTSMA is safe and effective for the treatment of patients with HOCM, and the long-term survival rate of patients after PTSMA is similar as patients undergoing classical surgical myectomy surgery.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cardiomyopathy, Hypertrophic/surgery , Catheter Ablation , China , Follow-Up Studies , Heart Septum , Retrospective Studies , Treatment OutcomeABSTRACT
0.05).Compared with non-myocardial infarction group,the prevalence of normal segmental ventricular wall motion and ejection fraction in myocardial infarction group was significantly lower,while those of akinesia and paradoxical motion were significantly higher(P
ABSTRACT
Objective To study the relationship between Noble grade and distribution of myocardial bridge and atherosclerosis. Methods The clinical data of 192 patients with myocardial bridge diagnosed by coronary artery angiography were retrospectively analysed.The clinical symptoms,electrocardiographic and echocardiographic findings were analysed to explore the relationship between Noble grade and distribution of myocardial bridge and atherosclerosis,and the outcomes of medical treatment were also investigated. Results The positive rate of myocardial bridge detected by coronary artery angiography was 10.2%,which was usually observed in the middle part of left anterior descending coronary artery.All the patients with grade 3 of Noble grade experienced chest pain or palpitation,43.8% had ischemic ST-T changes on electrocardiogram,and 37.5% had abnormal segmental ventricular wall on echocardiography.However,patients with Noble grade 1 and 2 did not have ischemic ST-T changes on electrocardiogram or abnormal segmental ventricular wall on echocardiography.The prevalence of atherosclerosis in proximal coronary artery of myocardial bridge was significantly higher than those of mural coronary artery and distal coronary artery(P