TY - JOUR
T1 - Timing of invasive septal reduction therapies and outcome of patients with obstructive hypertrophic cardiomyopathy
AU - Cavigli, Luna
AU - Fumagalli, Carlo
AU - Maurizi, Niccolò
AU - Rossi, Alessandra
AU - Arretini, Anna
AU - Targetti, Mattia
AU - Passantino, Silvia
AU - Girolami, Francesca
AU - Tomberli, Benedetta
AU - Baldini, Katia
AU - Tomberli, Alessia
AU - Antoniucci, David
AU - Yacoub, Magdi H.
AU - Marchionni, Niccolò
AU - Stefano, Pier Luigi
AU - Cecchi, Franco
AU - Olivotto, Iacopo
PY - 2018/12/15
Y1 - 2018/12/15
N2 - Background: Whether early vs. delayed referral to septal reduction therapies (SRT, alcohol septal ablation or surgical myectomy) bears prognostic relevance in hypertrophic obstructive cardiomyopathy (HOCM) is unresolved. We analyzed the impact of SRT timing on the outcome of HOCM patients. Methods: We followed 126 patients for 5 ± 4 years after SRT (mean age 53 ± 15 years; 55 post-ASA and 71 post-SM). Based on time-to-treatment (TTT; from HOCM diagnosis to SRT), patients were divided into three groups: “<3” years, N = 50; “3–5” years, N = 25; “>5” years, N = 51. Results: Patients with TTT > 5 years were younger at diagnosis and more often had atrial fibrillation (AF). Left ventricular outflow tract (LVOT) gradients were comparable in the 3 TTT groups. Two patients died peri-operatively, all with TTT > 5. Long-term, 8 patients died (3 suddenly and 5 due to heart failure). Mortality increased progressively with TTT (2% vs. 4% vs. 12% for TTT “<3”, “3–5”, and “>5” years, p for trend = 0.039). Independent predictors of disease progression (new-onset AF, worsening to NYHA III/IV symptoms, re-intervention or death) were TTT (“3–5” vs. “<3” years: HR: 4.988, 95%CI: 1.394–17.843; “>5” vs. “<3” years: HR: 3.420, 95%CI: 1.258–9.293, overall p-value = 0.025), AF at baseline (HR: 1.896, 95%CI: 1.002–3.589, p = 0.036) and LVOT gradient (HR per mm Hg increase: 1.022, 95%CI: 1.007–1.024, p = 0.023). Conclusions: Delay in SRT referral has significant impact on long-term outcome of patients with HOCM, particularly when >5 years from first detection of gradient, even when successful relief of symptoms and gradient is achieved. Earlier interventions are associated with lower complication rates and better prognosis, suggesting the importance of timely SRT to maximize treatment benefit and prevent late HOCM-related complications.
AB - Background: Whether early vs. delayed referral to septal reduction therapies (SRT, alcohol septal ablation or surgical myectomy) bears prognostic relevance in hypertrophic obstructive cardiomyopathy (HOCM) is unresolved. We analyzed the impact of SRT timing on the outcome of HOCM patients. Methods: We followed 126 patients for 5 ± 4 years after SRT (mean age 53 ± 15 years; 55 post-ASA and 71 post-SM). Based on time-to-treatment (TTT; from HOCM diagnosis to SRT), patients were divided into three groups: “<3” years, N = 50; “3–5” years, N = 25; “>5” years, N = 51. Results: Patients with TTT > 5 years were younger at diagnosis and more often had atrial fibrillation (AF). Left ventricular outflow tract (LVOT) gradients were comparable in the 3 TTT groups. Two patients died peri-operatively, all with TTT > 5. Long-term, 8 patients died (3 suddenly and 5 due to heart failure). Mortality increased progressively with TTT (2% vs. 4% vs. 12% for TTT “<3”, “3–5”, and “>5” years, p for trend = 0.039). Independent predictors of disease progression (new-onset AF, worsening to NYHA III/IV symptoms, re-intervention or death) were TTT (“3–5” vs. “<3” years: HR: 4.988, 95%CI: 1.394–17.843; “>5” vs. “<3” years: HR: 3.420, 95%CI: 1.258–9.293, overall p-value = 0.025), AF at baseline (HR: 1.896, 95%CI: 1.002–3.589, p = 0.036) and LVOT gradient (HR per mm Hg increase: 1.022, 95%CI: 1.007–1.024, p = 0.023). Conclusions: Delay in SRT referral has significant impact on long-term outcome of patients with HOCM, particularly when >5 years from first detection of gradient, even when successful relief of symptoms and gradient is achieved. Earlier interventions are associated with lower complication rates and better prognosis, suggesting the importance of timely SRT to maximize treatment benefit and prevent late HOCM-related complications.
KW - Alcohol septal ablation
KW - Hypertrophic obstructive cardiomyopathy
KW - Outcome
KW - Septal reduction therapies
KW - Surgical myectomy
KW - Timing
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U2 - 10.1016/j.ijcard.2018.09.004
DO - 10.1016/j.ijcard.2018.09.004
M3 - Article
C2 - 30213605
AN - SCOPUS:85053000416
VL - 273
SP - 155
EP - 161
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -