Long-term survival after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a comparison with general population

Veselka, Josef; Krejčí, Jan; Tomašov, Pavol; Zemánek, David

doi:10.1093/eurheartj/eht495

Cited by 88 publications

(58 citation statements)

References 29 publications

(24 reference statements)

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“…Periprocedural mortality of ASA in this study (0.9%) was low and comparable to that of other tertiary referral centers [8,11,21,22]. No further lethal ventricular arrhythmia occurred in the three successfully resuscitated patients during follow-up suggested the prognostic significance of periprocedural cardiac arrest was limited, which agreed with the role of VF complicating acute MI [21,23,24].…”

Section: Discussionsupporting

confidence: 83%

“…Several studies suggested age as an independent predictor of adverse events [8,21,25,28], whereas Cox regression analysis did not identify this variable as an independent risk factor of primary or secondary end point in this study, which was in line with Veselka et al [29]. We should note that age-related adverse events mainly occurred in patients older than 60 years [8,25,28].…”

Section: Discussionsupporting

confidence: 81%

“…No further lethal ventricular arrhythmia occurred in the three successfully resuscitated patients during follow-up suggested the prognostic significance of periprocedural cardiac arrest was limited, which agreed with the role of VF complicating acute MI [21,23,24]. Additionally, the numerically lower 1-year survival free from primary endpoint of ASA vs. conservative group (97.4% vs. 97.7%) was associated with mortality and aborted cardiac arrest occurred during the perioperative period in ASA group, whereas, in the conservative group, no in-hospital primary endpoint occurred.…”

Section: Discussionsupporting

confidence: 62%

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Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

et al. 2015

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 62%

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Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

et al. 2015

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“…Поскольку с этической точки зрения невозможно сопоставле-ние ЭСА с оптимальной медикаментозной терапией у симптоматических пациентов, данное вмешательство сравнивали с «золотым стандартом» лечения этого пула больных -хирургической миэктомией (ХМ). Таким образом, данная процедура укрепилась в комплексном лечении этих пациентов [1][2][3][4].…”

Section: Introductionunclassified

“…Под септальной редукционной терапией понимают любой из методов: хирургическую миэкто-мию либо этаноловую септальную аблацию [2]. В то же время в американских рекомендациях 2011 г.…”

Section: Introductionunclassified

Alcohol septal ablation: patient selection and rationality of its application

Kashtanov¹,

Chernyshev²,

Kardapoltsev³

et al. 2017

PKiK

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The article looks at some aspects of selecting patients with obstructive hypertrophic cardiomyopathy for alcohol septal ablation (ASA) procedure. Based on the world’s experience and in the context of evidence-based medicine, the current positions of ASA in complex treatment of obstructive hypertrophic cardiomyopathy are described. Received 29 September 2016. Accepted 9 January 2017.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsData collection and analysis: Kashtanov M.G. Drafting the article: Kashtanov M.G. Critical revision: Kashtanov M.G., Idov E.M., Chernyshev S.D., Kardapoltsev L.V., Berdnikov S.V.

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Mavacamten in Patients With Hypertrophic Cardiomyopathy Referred for Septal Reduction

Desai,

Owens,

Wolski

et al. 2023

JAMA Cardiol

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ImportanceThere is an unmet need for novel medical therapies before recommending invasive therapies for patients with severely symptomatic obstructive hypertrophic cardiomyopathy (HCM). Mavacamten has been shown to improve left ventricular outflow tract (LVOT) gradient and symptoms and may thus reduce the short-term need for septal reduction therapy (SRT).ObjectiveTo examine the cumulative longer-term effect of mavacamten on the need for SRT through week 56.Design, Setting, and ParticipantsThis was a double-blind, placebo-controlled, multicenter, randomized clinical trial with placebo crossover at 16 weeks, conducted from July 2020 to November 2022. Participants were recruited from 19 US HCM centers. Included in the trial were patients with obstructive HCM (New York Heart Association class III/IV) referred for SRT. Study data were analyzed April to August 2023.InterventionsPatients initially assigned to mavacamten at baseline continued the drug for 56 weeks, and patients taking placebo crossed over to mavacamten from week 16 to week 56 (40-week exposure). Dose titrations were performed using echocardiographic LVOT gradient and LV ejection fraction (LVEF) measurements.Main Outcome and MeasureProportion of patients undergoing SRT, remaining guideline eligible or unevaluable SRT status at week 56.ResultsOf 112 patients with highly symptomatic obstructive HCM, 108 (mean [SD] age, 60.3 [12.5] years; 54 male [50.0%]) qualified for the week 56 evaluation. At week 56, 5 of 56 patients (8.9%) in the original mavacamten group (3 underwent SRT, 1 was SRT eligible, and 1 was not SRT evaluable) and 10 of 52 patients (19.2%) in the placebo crossover group (3 underwent SRT, 4 were SRT eligible, and 3 were not SRT evaluable) met the composite end point. A total of 96 of 108 patients (89%) continued mavacamten long term. Between the mavacamten and placebo-to-mavacamten groups, respectively, after 56 weeks, there was a sustained reduction in resting (mean difference, −34.0 mm Hg; 95% CI, −43.5 to −24.5 mm Hg and −33.2 mm Hg; 95% CI, −41.9 to −24.5 mm Hg) and Valsalva (mean difference, −45.6 mm Hg; 95% CI, −56.5 to −34.6 mm Hg and −54.6 mm Hg; 95% CI, −66.0 to −43.3 mm Hg) LVOT gradients. Similarly, there was an improvement in NYHA class of 1 or higher in 51 of 55 patients (93%) in the original mavacamten group and in 37 of 51 patients (73%) in the placebo crossover group. Overall, 12 of 108 patients (11.1%; 95% CI, 5.87%-18.60%), which represents 7 of 56 patients (12.5%) in the original mavacamten group and 5 of 52 patients (9.6%) in the placebo crossover group, had an LVEF less than 50% (2 with LVEF ≤30%, one of whom died), and 9 of 12 patients (75%) continued treatment.Conclusions and RelevanceResults of this randomized clinical trial showed that in patients with symptomatic obstructive HCM, mavacamten reduced the need for SRT at week 56, with sustained improvements in LVOT gradients and symptoms. Although this represents a useful therapeutic option, given the potential risk of LV systolic dysfunction, there is a continued need for close monitoring.Trial RegistrationClinicalTrials.gov Identifier: NCT04349072

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Long-term survival after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a comparison with general population

Abstract: This study suggests that in patients with HOCM and important symptoms who underwent ASA, long-term survival after the procedure did not differ significantly from that of the general population.

Cited by 88 publications

References 29 publications

Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

Alcohol septal ablation: patient selection and rationality of its application

Mavacamten in Patients With Hypertrophic Cardiomyopathy Referred for Septal Reduction

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