Clinical Study Of Hypertrophic Cardiomyopathy

Part 1:Incidence of Ischemic Stroke and Systemic Embolism in Patients with Hypertrophic Cardiomyopathy, Nonvalvular Atrial Fibrillation, CHA2DS2-VASc score of≤1 and without Anticoagulant TherapyBackground:Data on the risk of ischemic stroke and systemic embolism (iSSE) events in patients with nonvalvular atrial fibrillation (NVAF), a CHA2DS2-VASc score of≤1, hypertrophic cardiomyopathy (HCM), and without anticoagulant therapy are still lacking. The aim of this study was to investigate the incidence of iSSE events in these patients.Methods:We consecutively screened medical records of patients with HCM and NVAF referred to Fuwai Hospital between January 1994 and March 2014. The primary end point was iSSE events, defined as a composite of ischemic stroke and systemic embolism. Follow-up was carried out to ascertain end point status.Results:Medical records of 522 patients with NVAF and HCM were screened. A total of 108 patients (20.7%) with a CHA2DS2-VASc score of≤1 and without anticoagulant therapy were enrolled and constituted our study population. After a median follow-up of 2.4 years (range,0.6 to 14.1 years; 376.2 patient-years), ischemic stroke occurred in 2 patients, resulting in death of 1 patient in the first year and paralysis of the other patient in the fourth year. No other iSSE events occurred. The incidence of iSSE was 0.9%[95% confidence interval (CI),0.0% to 5.0%] in the first year, and 0.5 per 100 patient-years (95% CI,0.1 to 1.9).Conclusions:The risk of iSSE events seems low in patients with NVAF, a CHA2DS2-VASc score of≤1, HCM, and without anticoagulant therapy. Multicenter studies with sizeable study populations are needed to validate the risk of iSSE events in these patients.Part 2:Survival after Alcohol Septal Ablation versus Conservative Therapy in Obstructive Hypertrophic CardiomyopathyBackground:The impact of alcohol septal ablation (ASA) on the survival of patients with drug-refractory obstructive hypertrophic cardiomyopathy (HCM) remains unresolved. The aim of this study was to compare survival after ASA versus conservative therapy.Methods:We studied a consecutive cohort of 274 patients with severe drug-refractory obstructive HCM,229 in ASA group and 45 in conservative group. The primary end point was a composite of all-cause mortality and aborted cardiac arrest.Results:With a median follow-up of 4.3 years, primary end point occurred in 13 patients in ASA group (5.7%), and 8 patients in conservative group (17.8%). The 5- and 10-year survival free from primary end point of ASA group (94.5% and 93.0%, respectively) was significantly better than that of conservative group (78.3% and 72.2%, respectively, log-rank p=0.009). Independent determinants of primary end point were ASA therapy (hazard ratio [HR],0.22; 95% confidence interval [CI],0.08 to 0.60; p=0.003) and maximal septal thickness (HR,1.14; 95% CI,1.03 to 1.27; p=0.011).Conclusions:In patients with severe drug-refractory obstructive HCM, survival after ASA is favorable and better than that of conservative therapy. ASA seems to improve survival.Part 3:Effectiveness of Alcohol Septal Ablation in Obstructive Hypertrophic Cardiomyopathy with versus without Extreme Septal HypertrophyBackground:Data on the effectiveness of alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM) and extreme septal hypertrophy (ESH) are lacking. This study aimed to compare the effectiveness of ASA in patients with versus without ESH.Methods:Clinical profiles of 17 patients with ESH and 256 patients without ESH were compared.Results:Baseline pressure gradient and limiting symptoms were comparable between patients with and without ESH. At median 1.1 years follow-up after ASA, pressure gradient was 48.5±40.4 mm Hg in the ESH group and 40.9±35.2mm Hg in the non-ESH (N-ESH) group (p=0.329). Patients with New York Heart Association (NYHA) class III/IV represented 5.9% of the ESH group and 16.9% of the N-ESH group (p= 0.392). Patients with Canadian Cardiovascular Society (CCS) class III/IV represented 5.9% of the ESH group and 10.2% of the N-ESH group (p=0.871).Conclusions:The effectiveness of ASA seems comparable between patients with and without ESH.