Efficacy comparison between conservative therapy and septal ablation in patients with hypertrophic obstructive cardiomyopathy
10.3760/cma.j.issn.0253-3758.2016.12.005
- VernacularTitle:间隔心肌消融术与药物保守治疗对梗阻性肥厚型心肌病疗效的对比
- Author:
Hua ZHAO
1
;
Jiqiang HE
;
Bei JIANG
;
Yuechun GAO
;
Quan LI
;
Changyan WU
;
Tengyong JIANG
Author Information
1. 100029,首都医科大学附属北京安贞医院心内科北京市心肺血管病研究所
- Keywords:
Cardiomyopathy,hypertrophic;
Catheter ablation;
Treatment outcome
- From:
Chinese Journal of Cardiology
2016;44(12):1015-1019
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the effects of septal ablation (SA) versus conservative medication (CM) on the hemodynamic,clinical status and survival in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods This retrospective study included 350 consecutive patients with HOCM (mean age (51.3 ± 13.5) years old) hospitalized in Anzhen Hospital between September 2002 to September 2014.The patients were followed up to 14 years and the follow up rate was 99.4％ (348/350).Overall and cardiac-related mortalities were compared between SA group (n =184) and CM group (n =184).Moreover,SA related cardiac function and hemodynamics improvement were also evaluated,predictors for clinical events were evaluated by Cox regression analysis and Kaplan-Meier survival analysis was used to compare the total mortality between the two groups.The log-rank test was used to compare the survival curve differences between the two groups.Results The median follow-up period was 4 years (1-14 years).The annual mortalities of SA and CM were 2.4％ and 0.6％ respectively (P ＜ 0.001) and cumulative sudden cardiac death (SCD) rates were 3.61％ (6/166) and 0.54％ (1/184) respectively (P =0.031).Multivariate regression analysis demonstrated that the age was the most important independent predictor for overall mortality(HR =1.259,95％ CI 1.101-1.438,P =0.001).In addition,left ventricular outflow tract (LVOT) gradient was significantly reduced post SA (peak velocity of LVOT:baseline (4.23:± 1.05) m/s,post SA:(1.83 ±0.79) m/s,P ＜0.01) and heart function was also significantly improved post SA (NYHA at baseline:2.97 ±0.29,post SA:1.74 ±0.53,P ＜0.001).Conclusion SA could significantly improve the hemodynamics and clinical status in drug-resistant patients with HOCM.In comparison to patients received CM,overall survival rate was significantly higher in SA group without extra risk of SCD.
