42 research outputs found
Medical therapy versus interventional therapy in hypertropic obstructive cardiomyopathy
Medical treatment in symptomatic patients with hypertrophic obstructive cardiomyopathy aims to reduce the outflow tract gradients, and to improve diastolic dysfunction and rhythm disorders. Surgical myectomy is the standard treatment in patients with drug refractory symptoms. Since the early 1990s, dual-chamber (DDD)-pacemaker implantation and percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion have widened treatment options in this subgroup of patients. An overview of medical and interventional treatment is presented
Outcome of Alcohol Septal Ablation in Mildly Symptomatic Patients With Hypertrophic Obstructive Cardiomyopathy: A Long-Term Follow-Up Study Based on the Euro-Alcohol Septal Ablation Registry
Background
The long‐term efficacy and safety of alcohol septal ablation (
ASA
) in patients with highly symptomatic hypertrophic obstructive cardiomyopathy has been demonstrated. The aim of this study was to evaluate the long‐term outcomes of mildly symptomatic patients with hypertrophic obstructive cardiomyopathy treated with
ASA
.
Methods and Results
We retrospectively evaluated consecutive patients enrolled in the Euro‐
ASA
registry (1427 patients) and identified 161 patients (53±13 years; 27% women) who were mildly symptomatic (New York Heart Association [
NYHA
] class
II
) pre‐
ASA
. The median (interquartile range) follow‐up was 4.8 (1.7–8.5) years. The clinical outcome was assessed and compared with the age‐ and sex‐matched general population. The 30‐day mortality after
ASA
was 0.6% and the annual all‐cause mortality rate was 1.7%, which was similar to the age‐ and sex‐matched general population (
P
=0.62). A total of 141 (88%) patients had resting left ventricular outflow tract gradient at the last clinical checkup ≤30 mm Hg. Obstruction was reduced from 63±32 to 15±19 mm Hg (
P
<0.01), and the mean
NYHA
class decreased from 2.0±0 to 1.3±0.1 (
P
<0.01); 69%, 29%, and 2% of patients were in
NYHA
class I,
II
, and
III
at the last clinical checkup, respectively.
Conclusions
Mildly symptomatic hypertrophic obstructive cardiomyopathy patients treated with
ASA
had sustained symptomatic and hemodynamic relief with a low risk of developing severe heart failure. Their survival is comparable to the general population.
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Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.Aims: The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.
Methods and results: 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI) and clinical traits was analyzed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene.The prevalence of HT, DM and obesity (Ob) was 37%, 10%, and 21%, respectively. HT, DM and Ob were associated with older age (p<0.001), less family history of HCM (HT and DM p<0.001), higher New York Heart Association (NYHA) class (p<0.001), atrial fibrillation (HT and DM p<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob p<0.001; DM p = 0.003). Stroke was more frequent in HT (p<0.001) and mutation-positive patients with DM (p = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT p<0.001, Ob p = 0.036). LV hypertrophy was more severe in Ob (p = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, p = 0.017 and OR 1.584, p = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.
Conclusion: Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.info:eu-repo/semantics/publishedVersio
A Decade of Percutaneous Septal Ablation in Hypertrophic Cardiomyopathy
Percutaneous septal ablation has emerged as a less invasive treatment of
symptomatic patients with hypertrophic obstructive cardiomyopathy
(HOCM). In the past decade, the availability of this sophisticated
technique has revived the interest of cardiologists in left ventricular
outflow tract obstruction, which led to the recognition that most
patients with HCM have the obstructive type. Follow-up studies have
already shown the safety and efficacy of the procedure, which offers
symptomatic relief in most patients. Long-term survival is comparable to
historical reports after surgical myectomy. Complications are rare and
can be further reduced with increased experience of the operators, and
the theoretical concern for possible ventricular arrhythmogenicity of
the myocardial scar has not been documented by the existing data.
Although there are still no randomized trials, percutaneous septal
ablation is undeniably a viable alternative for patients with HOCM.
(Circ J 2011; 75: 28-37
Hypertrophic cardiomyopathy as a cause of sudden death
Hypertrophic cardiomyopathy (HCM) is the main cause of sudden unexpected
death in the young and especially in young athletes with an incidence up
to 2.3 per 100,000 athletes and year. Risk stratification models
including patient history (syncope, familial risk of sudden death) and
findings in noninvasive tests (nonsustained ventricular tachycardia,
abnormal blood pressure response during exercise, maximum left
ventricular wall thickness a parts per thousand yen 30 mm) have been
developed in order to estimate the risk of individual patients.
Echocardiographic parameters are helpful in distinguishing HCM from
athlete’s heart. Definitive diagnosis of HCM implicates disqualification
from competitive sports resulting in a significant reduction of sudden
cardiac death due to HCM during sports competition. This positive
development should lead to a widespread preparticipation screening of
athletes including historical, clinical, and electrocardiographic
examination. At least in borderline findings and symptomatic athletes,
an additional echocardiogram should be performed in order to minimize or
better exclude the risk of sudden cardiac death