One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response

Faber, Lothar; Welge, Dirk; Fassbender, D; Schmidt, H. K.; Horstkotte, Dieter; Seggewiß, Hubert

doi:10.1007/s00392-007-0578-9

Cited by 77 publications

(69 citation statements)

References 33 publications

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“…Similarly, patients with flow-limiting coronary disease and diabetes mellitus were excluded to avoid the confounding influence of impaired cardiac energetic status associated with these disorders. 41 Multiple objective and independent parameters (ie, PCr/ATP, nTTPF, and V o 2 ) were assessed to obviate the biases that may confound interpretation of phase 2 trials. The PCr/ATP ratio was measured at rest; we speculate that the impact of perhexiline on PCr/ATP would be more striking in exercise, but current technology does not permit dynamic magnetic resonance spectroscopy measurements.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Modulator Perhexiline Corrects Energy Deficiency and Improves Exercise Capacity in Symptomatic Hypertrophic Cardiomyopathy

et al. 2010

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Background-Hypertrophic cardiomyopathy patients exhibit myocardial energetic impairment, but a causative role for this energy deficiency in the pathophysiology of hypertrophic cardiomyopathy remains unproven. We hypothesized that the metabolic modulator perhexiline would ameliorate myocardial energy deficiency and thereby improve diastolic function and exercise capacity. Methods and Results-Forty-six consecutive patients with symptomatic exercise limitation (peak V o 2 Ͻ75% of predicted) caused by nonobstructive hypertrophic cardiomyopathy (mean age, 55Ϯ0.26 years) were randomized to perhexiline 100 mg (nϭ24) or placebo (nϭ22). Myocardial ratio of phosphocreatine to adenosine triphosphate, an established marker of cardiac energetic status, as measured by 31 P magnetic resonance spectroscopy, left ventricular diastolic filling (heart rate normalized time to peak filling) at rest and during exercise using radionuclide ventriculography, peak V o 2 , symptoms, quality of life, and serum metabolites were assessed at baseline and study end (4.6Ϯ1.8 months). Perhexiline improved myocardial ratios of phosphocreatine to adenosine triphosphate (from 1.27Ϯ0.02 to 1.73Ϯ0.02 versus 1.29Ϯ0.01 to 1.23Ϯ0.01; Pϭ0.003) and normalized the abnormal prolongation of heart rate normalized time to peak filling between rest and exercise (0.11Ϯ0.008 to Ϫ0.01Ϯ0.005 versus 0.15Ϯ0.007 to 0.11Ϯ0.008 second; Pϭ0.03). These changes were accompanied by an improvement in primary end point (peak V O 2 ) (22.2Ϯ0.2 to 24.3Ϯ0.2 versus 23.6Ϯ0.3 to 22.3Ϯ0.2 mL ⅐ kg Ϫ1 ⅐ min Ϫ1 ; Pϭ0.003) and New York Heart Association class (PϽ0.001) (all P values ANCOVA, perhexiline versus placebo). Conclusions-In symptomatic hypertrophic cardiomyopathy, perhexiline, a modulator of substrate metabolism, ameliorates cardiac energetic impairment, corrects diastolic dysfunction, and increases exercise capacity. This study supports the hypothesis that energy deficiency contributes to the pathophysiology and provides a rationale for further consideration of metabolic therapies in hypertrophic cardiomyopathy. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00500552.

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Section: Discussionmentioning

confidence: 99%

Metabolic Modulator Perhexiline Corrects Energy Deficiency and Improves Exercise Capacity in Symptomatic Hypertrophic Cardiomyopathy

et al. 2010

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“…Residual gradients may not be tolerated by younger or highly active individuals. 28,29 Given that suboptimal outcomes with septal ablation in relatively younger patients have been observed in some studies, consideration has been given to surgical myectomy as the preferred method for septal reduction therapy in this population, especially those Ͻ40 years of age. 4,21,28,30,31 Nevertheless, it is important to note that this study did not examine potential impact of subacute remodeling and changes in LVOT gradient in follow-up on long-term outcome.…”

Section: Sorajja Et Al Survival After Septal Ablation 2377mentioning

confidence: 99%

“…28 Importantly, septal ablation was only performed after a comprehensive, multidisciplinary evaluation in a setting where surgical myectomy is readily offered to all HCM patients presenting for therapy of drug-refractory symptoms. Procedural mortality for septal ablation was low (1.4%), but other complications are more frequent than with surgery.…”

Section: Sorajja Et Al Survival After Septal Ablation 2377mentioning

confidence: 99%

Survival After Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

et al. 2012

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Background-The clinical efficacy of alcohol septal ablation for obstructive hypertrophic cardiomyopathy (HCM) has been demonstrated, but the long-term effects of the procedure remain uncertain. This study examined the survival of patients after septal ablation performed in a tertiary HCM referral center. Methods and Results-We examined 177 patients (mean age, 64 years; 68% women) who underwent septal ablation at our institution. Over a follow-up of 5.7 years, survival free of all mortality was no different than the expected survival for a comparable general population, and similar to that of age-and sex-matched patients who underwent isolated surgical myectomy (8-year survival estimate, 79% versus 79%; Pϭ0.64). For the end point of documented sudden cardiac death or unknown cause of death, the incidence per 100 person-year follow-up was 1.31 (95% confidence interval, 0.60-2.38). Residual left ventricular outflow tract gradient after ablation was an independent predictor of long-term survival free of any death. Conclusions-In this nonrandomized study of carefully selected patients undergoing septal ablation by experienced operators in a tertiary referral HCM center, long-term survival was favorable and similar to that of an age-and sex-matched general population, and to patients undergoing surgical myectomy, as well, without an increased risk of sudden cardiac death. (Circulation. 2012;126:2374-2380.)

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“…[10][11][12][13][14] However, the influence of the degree of septal hypertrophy on the outcome after ASA in patients with HCM has been described only briefly. 11 In this multicenter registry study, we evaluated the influence of the degree of septal hypertrophy at baseline on the clinical outcome and survival after ASA treatment.…”

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confidence: 99%

Influence of Septal Thickness on the Clinical Outcome After Alcohol Septal Alation in Hypertrophic Cardiomyopathy

Jensen

Jacobsson

Almaas

et al. 2016

Circ: Cardiovascular Interventions

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One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response

Cited by 77 publications

References 33 publications

Metabolic Modulator Perhexiline Corrects Energy Deficiency and Improves Exercise Capacity in Symptomatic Hypertrophic Cardiomyopathy

Metabolic Modulator Perhexiline Corrects Energy Deficiency and Improves Exercise Capacity in Symptomatic Hypertrophic Cardiomyopathy

Survival After Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

Influence of Septal Thickness on the Clinical Outcome After Alcohol Septal Alation in Hypertrophic Cardiomyopathy

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