Follow-Up of Alcohol Septal Ablation for Symptomatic Hypertrophic Obstructive CardiomyopathyThe Baylor and Medical University of South Carolina Experience 1996 to 2007
Valerian L. Fernandes, MD*,
Christopher Nielsen, MD*,
Sherif F. Nagueh, MD ,
Amy E. Herrin, MS ,
Christine Slifka, RN*,
Jennifer Franklin, RN,
William H. Spencer, III, MD*,*
* Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
Division of Cardiology, Methodist-DeBakey Heart Center, Houston, Texas
Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina
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Figure 1 NYHA/CCS Score (Subjective) and Treadmill Exercise Time (Objective) Parameters During Follow-Up After ASA
There was marked early improvement of heart failure symptoms (New York Heart Association [NYHA] score) and angina (Canadian Cardiovascular Society [CCS] score) at 3 months, and this improvement persisted during follow-up. This also correlated with improvement in treadmill exercise time. ASA = alcohol septal ablation; BL = baseline.
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Figure 2 Resting and Provoked LVOT Gradients During Follow-Up After ASA
There is a marked reduction in both resting and provoked left ventricular outflow tract (LVOT) gradients at 3 months after alcohol septal ablation (ASA). There is further reduction of gradients until 5 years, and this improvement persisted during follow-up. BL = baseline.
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Figure 3 Septal Thickness During Follow-Up After ASA
There was marked reduction of septal thickness at 3 months after alcohol septal ablation and further gradual reduction during follow-up. Abbreviations as in Figure 1.
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Figure 4 Ejection Fraction During Follow-Up After ASA
The ejection fraction, which was hyperdynamic at baseline, declined gradually but remained in normal range during follow-up. Abbreviations as in Figure 1.
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Figure 5 Kaplan-Meier All-Cause Mortality
The 1-year survival estimate for all-cause mortality is 0.97 (95% confidence interval [CI]: 0.95 to 0.98). After the 1-year mark, 565 individuals were still at risk for death and were being followed up in the study. The 5-year survival estimate is 0.92 (95% CI: 0.90 to 0.94), with 272 individuals still at risk for death. At the 8-year time point, the survival estimate is 0.89 (95% CI: 0.86 to 0.92), with 130 individuals at risk. Pts = patients.
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Figure 6 Kaplan-Meier Event-Free Survival
Procedural deaths, repeat procedures, and surgeries (myectomy, mitral/aortic valve surgery) were all included as events in this analysis. Deaths from causes other than procedural deaths were censored at the time of death. Of the 627 individuals in this analysis, 113 had an event. The 1-year survival estimate and 95% confidence interval (CI) is 0.88 (95% CI: 0.85 to 0.91), with 509 patients at risk at the 1-year time point. The 5-year survival estimate and confidence interval is 0.80 (95% CI: 0.77 to 0.83), with 249 patients at risk. Pts = patients.
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