Study On Percutaneous Septal Myocardial Ablation Of Hypertrophic Obstructive Cardiomyopathy

Ⅰ Long-term prognosis of alcohol septal ablation for hypertrophic obstructive cardiomyopathyBackground and objectiveHypertrophic obstructive cardiomyopathy(HOCM) is the herited disease, which is characteristic of asymmetric hypertrophic cardiomyopathy, left ventricular volume decreased, the left ventricular diastolic function decreased. About 2/3 of the patients have left ventricular outflow tract obstruction in resting or excited state,which is a major cause of death and heart failure in patients. Treatment options for hypertrophic obstructive cardiomyopathy patients who remain symptomatic despite medical therapy are surgical myectomy and alcohol septal ablation(ASA).Surgical operation is the golden standard of treatment. Alcohol septal ablation is an alternative therapeutic option. The long-term prognosis remains uncertain. Wheather there is an increase incidence of malignant arrhythmia and sudden death after alcohol septal ablation remains uncertain. This study isto determine the long-term prognosis of patients after alcohol septal ablation for hypertrophic obstructive cadiomyopathy.MethodThrough access to medical records of patients,We get generalinformation, medical history, data of ASA and complications during hospitalization. The clinical manifestations of patients were followed up by telephone or outpatient.For deceased patients,interviews with next of skin was performed to determine cause of death.The Kaplan-Meir method was used to estimste survival of end points.record the survival curve, The Cox regression analysis was used to determine the independent risk factors influencing the prognosis.ResultA total of 227 consecutive patients(age,47.74±11.65years,64.8%men) treated by ASA were included from Sep.2005 to Dec.2013 and followed-up for 4.42years. (range,1.17,9.93years).In hospital,one death occurred because of retroperitoneahemorrhageAfter follow up,NYHA class was reduced(1.57±0.71vs 2.88±0.62,P=0.000). The incidence of syncope and amaurotic was reduced.(2.6%vs39.2%,P=0.035).The left ventricular outflow gradient was significantly reduced(42.67±35.31mmHg vs 89.69±32.13mmHg,P=0.000).Left atrium diameter was reduced(38.19±5.59mm vs 41.15±5.59mm,p=0.000).Basal septal thickness was reduced(18.18±5.79mm vs20.53±5.52mm,P=0.001).A total of six death occurred, four cardiac death occurred, among them three sudden death occurred.One patient died of cerebral embolism, one patient died of rectal cancer.Onecerebral hemorrhageoccurred.Six new atrial fibrillationoccurred.One Permanent pacemaker implantation occurred. Eight Myocardial resectionoccurred. Three secondary septal ablationoccurred.Survival free of all-cause mortality at 1,5,10 year was 100%,96%,96%. Residual left ventricular outflow tract gradient after ablation,the volume of injected ethanol,the incidence of temporary complele atrioventricular block were independent predictors of long-term survival free of cardiac death and NYHA Ⅲ/Ⅳ.ConclusionThis study suggests that in patients with HOCM and important symptoms who underwent ASA,long-term survival is good.Residual left ventricular outflow tract gradient after ablation,the volume of injected ethanol,the incidence of temporary complele atrioventricular block were independent predictors of long-term survival free of cardiac death and NYHA Ⅲ/Ⅳ.Ⅱ Predictive value of Plasma amino-terminal pro-B-type natriuretic peptide levels in patients with hypertrophic obstructive cardiomyopathy afteralcohol septal ablationBackground and objectivePlasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is a peptide molecules, secreted by cardiomyocytes, When ventricular wall tension increased.NT-proBNP is secreted increasingly. It can diagnose and predict the prognosis of heart failure.In hypertrophic obstructive cardiomyopathy, ventricular wall tension is increased,NT-proBNP level is increased. Alcohol septal ablation(ASA) is an effective option for the treatment of hypertrophic obstructive cardiomyopathy, how theNT-proBNP level changes after ASA is not invested.MethodsPlasma NT-proBNP levels was assessed in 80 patients with HCM.with enzyme linked immune method.Symptomatic status was assessed according to the New York Heart Association (NYHA) classification. M-mode and Doppler echocardiographic data were obtained in all patients.Serial changes in NT-proBNP in plasma and echocardiographic data were examined 2-3 days and long-term follow up. According to the left ventricular outflow tract pressure gradient (LVOTPG) decreased 50% when followed up,the patients were divided into good prognosis group and poor prognosis group. We compare the changes of NT-proBNPlevel after ASA between two groups.ResultsIn 82 patients NT-proBNP were determined before ASA. In group of high level of NT-proBNP, the thickness of interventricular septum(23.66±6.46 vs 20.79±4.56mm, P=0.035) and left ventricular posterior wall thickness(12.79 ±2.99 vs 11.50± 2.35mm, p=0.048), maximal ventricular posterior wall thickness(28.03±5.66vs25.18 ±4.81mm, P=0.02), left atrial diameter(40.73±4.86 vs 38.08±6.17mm, P=0.049) were significantly higher than the group of low levels ofNT-proBNP.NT-proBNP levels increased after2-3days ofASA, (1841.79±1310.88vs1552.15±951.57fmol/ml, P=0.066). NT-proBNP decreased significantly in the long-term follow-up(1038.46± 714.03vs1552.15±951.57fmol/ml, P=0.000).NT-proBNP level decreased more significantly in good prognosis group than poor prognosis group.(760.52± 1029.24vs113.72±646.42fmol/ml, P=0.005).ConclusionPlasma NT-proBNP levels could be useful to predict the effects of alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy. ⅢCorrelation of the prognosis of alcohol septal ablation in hypertrophicobstructive cardiomyopathy and the septal branch characteristicsBackgroundand objectiveAlcohol septal ablation(ASA) is an effective method for the treatment of hypertrophic obstructive cardiomyopathy. It can effectively remove the outflow tract obstruction, relieve symptoms and improve prognosis.The principle is to through the injection of absolute alcohol to the septal branch, the corresponding perfusion has myocardial necrosis, hypertrophic myocardial become thinner, left ventricular outflow tract is widened.Myocardial contrast echocardiography can help to choose the target septal branch, improve the success of the operation, but there are still some patients with residual left ventricular outflow tract pressure.It may have some correlation with the characteristics and distribution of the septal branch. How to choose the appropriate patients, how to determine the target septal branch of ablation is the key to the success of ASA. Correlation study on septal branchcharacteristics and ASA outcome was scarcelyreported. In this study, by analyzing the difference of characteristics of septal branch between the good prognosis group and the poor prognosis,We aim to explore how to select the appropriate patient to ablate according to the characteristics of coronary artery in patients in order to improve the operation effect.MethodsClinical,echocardiographic,angiographic and procedural characteristics were analyzed in 50 patients.Good prognosis was defined left ventricular outflow tract gradient decreased 50%. at long term follow-up.Analyzecoronary artery angiographyusing the method of QCA.ResultsCompared with bad prognosis group,the diameter of ablated septal branch was significantly larger in good prognosis group(1.75±0.36mm vs1.48±0.41mm, P=0.012).The distance between ablated branch and adjacent branch is greater in good prognosis group.(18.80±10.20mm vs13.04±6.65mm, P=0.020). In multivariate analysis, the diameter ofthe ablated branch (OR6.652 (1.445-30.626), P=0.015)and the distance betweenablated septal branches and adjacent septall branch (OR1.102 (1.213-1.002),P=0.046) are independent risk factors of the good prognosis of ASA.ConclusionThe characteristics of septal coronary has certain correlation with ASA prognosis The diameter of ablated septal branch and the distance of ablated septal branch to the adjacent septal branch are associated with good outcome after ASA.