1
|
Verheyen N, Batzner A, Zach D, Zirlik A, Gerull B, Stoerk S, Maack C, Seggewiss H, Morbach C. Quantification of systolic anterior motion of the mitral valve to predict left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with hypertrophic cardiomyopathy (HCM), left ventricular outflow tract obstruction (LVOTO) is associated with an increased risk of heart failure and death (1). It is typically caused by dynamic systolic anterior motion (SAM) of the mitral valve leaflet. SAM can be categorized by echocardiography but diagnostic accuracy is limited by high inter-observer variability.
Purpose
To investigate the accuracy of echocardiographic parameters quantifying systolic motion of the mitral valve leaflets to identify LVOTO in patients with HCM.
Methods
We present a cross-sectional analysis of the HyperCard Registry, a prospective single-center cohort study enrolling consecutive patients with suspected or confirmed HCM. For the present analysis, patients with confirmed HCM and a valid standardized transthoracic echocardiographic were included. LVOT gradients were measured at rest and during Valsalva maneuver using continuous wave Doppler. In patients with clinical suspicion of dynamic LVOTO, further provocation maneuvers were conducted. LVOTO was defined as a maximal peak LVOT gradient ≥30 mmHg. Parameters quantifying systolic motion of the mitral valve were measured in parasternal and apical views, both at early and late systole, by an investigator blinded to individual patient characteristics. SAM was visually assessed and categorized into grade 0 (no SAM), I (leaflet motion towards LVOT), II (late systolic septal contact), and III (early systolic septal contact).
Results
We analyzed 142 patients (59±13 years, 42% women). LVOTO was present in 68 (48%) patients of whom 30 (21% of all) exhibited LVOTO at rest, and 38 (27% of all) had LVOTO only during provocation maneuvers (ie. dynamic LVOTO). SAM was present in 86 patients (60%) and had a sensivitiy, specificity and PPV of LVOTO of 91%, 69% and 73%, respectively (table). The late-systolic distance between mitral leaflet tip and anterior septum (TISls) measured in apical 3-chamber view was best associated with the degree of SAM (F=123, P<0.001), and with peak LVOT gradient (at rest: Pearson r=−0.817; during Valsalva maneuver: r=−0.816, both P<0.001). In ROC analyses (figure), the AUC of TISls for identification of LVOTO and dynamic LVOTO were 0.914 (95% CI 0.868–0.959) and 0.857 (0.786–0.927), respectively. TISls ≤14 mm had a 97% sensitivity for LVOTO and of 94% for dynamic LVOTO. TISls ≤9 mm showed specificity and PPV of 95% and 92% for LVOTO, and 94% and 83% for dynamic LVOTO, respectively.
Conclusions
Quantification of SAM by TISls showed high diagnostic accuracy in identifying HCM patients with LVOTO. Prospective studies are needed to assess the incremental benefit of this novel parameter in the diagnostic work-up of HCM patients.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N Verheyen
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - A Batzner
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - D Zach
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - A Zirlik
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - B Gerull
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - S Stoerk
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - C Maack
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - H Seggewiss
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - C Morbach
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| |
Collapse
|
2
|
Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
Collapse
Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Batzner A, Seggewiss H, Hahn P, Sahiti F, Maack C, Gerull B, Stoerk S, Morbach C. Myocardial work in hypertrophic cardiomyopathy - a new non-invasive parameter for segmental myocardial function? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): DFG
Introduction
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Alcohol septal ablation (PTSMA) is an established treatment option for patients with intracavitary obstruction. In non-obstructive patients, measurement of myocardial work (MW) using pressure strain loops was introduced as a new non-invasive tool to estimate myocardial performance.
Purpose
In this preliminary study, we compared global constructive work (GCW) and global wasted work (GWW) as well as the respective values for the septal- and lateral-basal segments in HOCM after successful PTSMA and non-obstructive HCM.
Methods
We included 12 patients (4 women, mean age 59.1 ± 17.6 years) with non-obstructive (maximal left ventricular gradient <30 mmHg; mean 10.6 ± 6.2 mmHg) HCM. 7 (58%) patients (subgroup A) had successful gradient reduction by PTSMA ≥3 months before analysis, whereas 5 patients had non-obstructive HCM (subgroup B). Using echocardiographic measurements of longitudinal strain and non-invasive measurements of peripheral- and calculated (PWA) central blood pressure (BP) as left ventricular systolic pressure (LVSP), we estimated and compared GCW and GWW as well as constructive work (CW) and wasted work (WW) of septal-basal and lateral-basal segments.
Results
In subgroup B, NTproBNP was significant higher than in subgroup A (2050 ± 1957 vs. 552 ± 845 pg/ml; p < 0.05). There were no differences between both subgroups in maximal septal thickness (20.7 ± 2.9 mm (A) vs. 22.2 ± 3.6 mm) and left atrial volume (91.6 ± 33.0 (A) vs. 114.0 ± 49.8 ml (B)). Using the measured peripheral BP as LVSP, GCW (1653 ± 347 (A) mmHg% vs 1641 ± 698mmHg%) and GWW (171 ± 89mmHg% (A) vs. 200 ± 126 mmHg%) showed no differences between both subgroups. Compared to published data of a healthy population, values of GCW were lower and values of GWW higher in HCM. Comparison in segmental analysis in subgroup A showed lower CW in septal-basal than in lateral-basal segments (1032 ± 385mmHg% vs. 1929 ± 699 mmHg%). In the subgroup B the finding was the same pattern (1024 ± 504mmHg% vs. 2301 ± 1069 mmHg%). In contrast, WW showed no difference between basal-septal and lateral-basal segments in both subgroups.
Conclusions
Our preliminary data show decreased GCW and increased GWW in HCM patients without obstruction at rest. As expected, we found lower CW in septal-basal segments than lateral-basal in patients after PTSMA with basal-septal-induced therapeutic infarction. Surprisingly, we found the same pattern in non-obstructive HCM patients. This finding might be one pathophysiological reason for not developing LVOT obstruction, which should be investigated in further detail.
Collapse
Affiliation(s)
- A Batzner
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - H Seggewiss
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - P Hahn
- University Hospital of Wurzburg, Wurzburg, Germany
| | - F Sahiti
- University Hospital of Wurzburg, Wurzburg, Germany
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - B Gerull
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - S Stoerk
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - C Morbach
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| |
Collapse
|
4
|
Batzner A, Aicha D, Pfeiffer B, Neugebauer A, Seggewiss H. Does age influence follow-up after alcohol septal ablation in hypertrophic obstructive cardiomyopathy? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Since its introduction in 1995 alcohol septal ablation (PTSMA) was discussed as treatment option only in elderly patients with symptomatic obstructive HCM (HOCM). We report on long-term follow-up after PTSMA with respect to patient's age.
Methods and results
Between 5/2000 and 6/2017 we treated 952 consecutive symptomatic HOCM patients (pts) with first PTSMA in our center. 132 (13.9%) pts were <40 years of age (Group A; mean age 30.3±7.7), 421 (44.2%) pts between ≥40 to <60 years of age (Group B; mean age 50.5±5.9) and 399 (41.9%) pts ≥60 years of age (Group C; 69.6±6.3). Family history (FH) of HCM was more often seen in Group A (50% vs. 25.7% (B) and 13.3% (C); p<0.ehab724.17611) as FH of sudden cardiac death (SCD) (17.4% vs. 11.2% (B) and 7.0% (C); p<0.01). Pts in Group C were more often in NYHA class III/IV (80.7%; p<0.001 each) compared to Group A (68.2%) and B (67.9%). At the time of PTSMA an ICD for primary SCD prevention had been more often implanted in Group A (19.8%; p<0.0001) compared to Group B (10.1%) and C (5.9%).
Echocardiographic measurements showed higher maximal septal thickness in Group A (23.9±5.7 mm; p<0.ehab724.17611 each) compared to Group B (20.9±4.0 mm) and C (20.1±3.5 mm). Pts of Group B had lower resting gradients (60.0±35.3 mmHg; p<0.01 each) compared to Group A (69.5±34.8 mmHg) and C (66.4±41.6 mmHg). Total heart block at PTSMA was less often seen in Group A (28.8%; p<0.05 each) compared to Group B (39.4%) and C (43.4%). Due to persistent total heart block need of permanent pacemaker implantation was lowest in Group A (3.8%, p<0.01 each) compared to Group B (9.3%) and C (14.0%) during hospital stay. One patient in Group A and C died during hospital stay, each.
Follow-up was longer in Group A (6.7±5.2 years) compared to Group C (5.5±4.8 years; p<0.05) and was comparable to Group B (6.2±5.1 years). Re-PTSMA was more often performed in Group A (22.7%; p<0.01 each) compared to Group B (12.8%) and Group C (10.5%). Reported clinical improvement at latest follow-up was comparable (93.3% Group A, 93.8% Group B, and 95.5% Group C). Mortality was highest in Group C (12.5%; p<0.0001 each) compared to Group A (1.5%) and B (4.0%). In Group A no pt died from cardiac reason, whereas 5 pts died from cardiac reasons in Group B and C, each. SCD was not observed in Group A, whereas 2 pts in Group B and 1 pt in Group C suffered SCD.
Conclusion
PTSMA is feasible even in young pts with symptomatic HOCM. Mortality after PTSMA is mainly due to non-cardiac reasons and more often seen in elderly pts. Especially, SCD could be observed in younger pts <40 years of age.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Batzner
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - D Aicha
- Leopoldina Hospital, Medizinische Klinik 1, Schweinfurt, Germany
| | - B Pfeiffer
- Leopoldina Hospital, Medizinische Klinik 1, Schweinfurt, Germany
| | - A Neugebauer
- Leopoldina Hospital, Medizinische Klinik 1, Schweinfurt, Germany
| | - H Seggewiss
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| |
Collapse
|
5
|
Pelliccia F, Seggewiss H, Cecchi F, Calabrò P, Limongelli G, Alfieri O, Ferrazzi P, Yacoub MH, Olivotto I. Septal Ablation Versus Surgical Myomectomy for Hypertrophic Obstructive Cardiomyopathy. Curr Cardiol Rep 2021; 23:165. [PMID: 34599387 PMCID: PMC8486700 DOI: 10.1007/s11886-021-01600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Patients with hypertrophic cardiomyopathy (HCM) who have left ventricular outflow tract obstruction (LVOTO) often experience severe symptoms and functional limitation. Relief of LVOTO can be achieved by two invasive interventions, i.e., surgery myectomy and alcohol septal ablation (ASA), leading in experienced hands to a dramatic improvement in clinical status. Despite extensive research, however, the choice of the best option in individual patients remains challenging and poses numerous clinical dilemmas. RECENT FINDINGS Invasive strategies have been recently incorporated in recommendations for the diagnosis and treatment of HCM on both sides of the Atlantic. These guidelines are based on a bulk of well-designed but retrospective studies as well as on expert opinions. Evidence now exists that adequate evaluation and management of HCM requires a multidisciplinary team capable of choosing the best available options. Management of LVOTO still varies largely based on local expertise and patient preference. Following the trend that has emerged for other cardiac diseases amenable to invasive interventions, the concept of a "HCM heart team" is coming of age.
Collapse
Affiliation(s)
- F Pelliccia
- Department of Cardiovascular Sciences, University Sapienza, Via del Policlinico 155, 00161, Rome, Italy.
| | - H Seggewiss
- Comprehensive Heart Failure Center (CHFC), Deutsches Zentrum Für Herzinsuffizienz (DZHI), Universitätsklinikum Würzburg, Würzburg, Germany
| | - F Cecchi
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - P Calabrò
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - G Limongelli
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.,Institute of Cardiovascular Sciences, University College of London, St. Bartholomew's Hospital, London, UK
| | - O Alfieri
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - P Ferrazzi
- Hypertrophic Cardiomyopathy Center, Policlinico Di Monza, Monza, Italy
| | - M H Yacoub
- Heart Science Centre, National Heart and Lung Institute, Imperial College London, London, UK
| | - I Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
6
|
Batzner A, Aicha D, Seggewiss H. Is alcohol septal ablation in women performed too late? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Alcohol septal ablation (PTSMA) was introduced as interventional alternative to surgical myectomy for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) 25 years ago. As gender differences in diagnosis and treatment of HOCM are still unclear we analyzed baseline characteristics and results of PTSMA in a large single center cohort with respect to gender.
Methods and results
Between 05/2000 and 06/2017 first PTSMA in our center was performed in 952 patients with symptomatic HOCM. We treated less 388 (40.8%) women and 564 (59.2%) men. All patients underwent clinical follow-up.
At the time of the intervention women were older (61.2±14.9 vs. 51.9±13.7 years; p<0.0001) and suffered more often from NYHA grade III/IV dyspnea (80.9% vs. 68.1%; p<0.0001), whereas angina pectoris was comparable in women (62.4%) and men (59.9%). Echocardiographic baseline gradients were comparable in women (rest 65.0±38.1 mmHg and Valsalva 106.2±45.7 mmHg) and men (rest 63.1±38.3 mmHg and Valsalva 103.6±42.8 mmHg). But, women had smaller diameters of the left atrium (44.3±6.9 vs. 47.2±6.5 mm; p<0001), maximal septum thickness (20.4±3.9 vs. 21.4±4.5 mm; p<0.01), and maximal thickness of the left ventricular posterior wall (12.7±2.8 vs. 13.5±2.9 mm; p<0.0001).
In women, more septal branches (1.3±0.6 vs. 1.2±0.5; p<0.05) had to be tested to identify the target septal branch. The amount of injected alcohol was comparable (2.0±0, 4 in women vs. 2.1±0.4 ml in men). The maximum CK increase was lower in women (826.0±489.6 vs. 903.4±543.0 U / l; p<0.05). During hospital stay one woman and one man died, each (n.s.). The frequency of total AV blocks in the cathlab showed no significant difference between women (41.5%) and men (38.3%). Furthermore, the rate of permanent pacemaker implantation during hospital stay did not differ (12.1% in women vs. 9.4% in men).
Follow-up periods of all patients showed no significant difference between women (5.7±4.9 years) and men (6.2±5.0 years). Overall, 37 (9.5%) women died during this period compared to only 33 (5.9%) men (p<0.05). But, cardiovascular causes of death were not significantly different between women (2.8%) and men (1.6%). Furthermore, the rates of surgical myectomy after failed PTSMA (1.3% in women vs. 2.3% in men), ICD implantation for primary prevention of sudden cardiac death according to current guidelines (4.1% in women vs. 5.9% in men) or pacemaker implantation (3.6% in women vs. 2.0% in men) showed no significant differences.
Summary
PTSMA in women with HOCM was performed at more advanced age with more pronounced symptoms compared to men. While there were no differences in acute outcomes, overall long-term mortality was higher in women without differences in cardiovascular mortality. Therefore, women may require more intensive diagnostic approaches in order not to miss the correct time for gradient reduction treatment.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A Batzner
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - D Aicha
- Leopoldina Hospital, Schweinfurt, Germany
| | - H Seggewiss
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| |
Collapse
|
7
|
Seggewiss H, Schurig N, Lempert T. Management of conflicts of interests of ESC guideline authors. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
According to WHO definition medical guidelines are systematically developed statements to support the decisions of clinicians and patients about appropriate health care for specific clinical situations. Guidelines should be based on on results of randomized trials and independence from economic interests. Therefore, not only detailed declaration but also active management of conflicts of interests (COI) of guideline committee members should be declared. The public database LeitlinienWatch (GuidelineWatch) analyzes German and European guidelines with respect to COI declaration and management.
Methods
Between 2015 and 2019 nine German National Standard of Care guidelines (NVL), 10 German Cancer Society (DKG) guidelines, and 10 ESC guidelines were compared according to five criteria. Each criterion was scored 0–3 points (Table). Furthermore, up to 3 extra points could be awarded for methodological quality.
Results
Overall, guidelines of NVL (11.3±3.5) and DKG (9.8±3.3) achieved more points than ESC guidelines (2.8±0.4; p<0.00001). ESC-guidelines scored points only by documentation of COI and sometimes an extra bonuspoint for an internal review process. In all ESC guidelines >50% of the authors had COI. These conflicts did not lead to an exclusion of lead authors or abstentions from voting. A public accessible review was standard practice in NVL-guidelines and more often performed in DKG-guidelines but was lacking in ESC guideline process. Overall, NVL- and DKG-guidelines showed better handling of COI (Table).
Conclusion
Declaration and management of COI are quality criteria for medical guidelines. Current ESC guidelines do not meet international standards for COI management. Therefore, the rules for the ESC guideline process need to be revised.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
| | | | - T Lempert
- Schlosspark Klinik, Dept. of Neurology, Berlin, Germany
| |
Collapse
|
8
|
Faber L, Scholtz S, Batzner A, Seggewiss H. What happens >10 years after percutaneous septal ablation for hypertrophic obstructive cardiomyopathy? Ultra long-term follow-up of 120 patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction and methods
Recent registry analyses including the European multicenter registry (Euro-ASA) documented a favourable long-term outcome of septal ablation (ASA/PTSMA) competitive to surgical myectomy. There is no information about the period beyond 10 years. We therefore analyzed the outcome in 120 HOCM patients (pts., mean age @ index intervention: 62±13 years) treated with ASA who survived >10 years.
Results
Mean CK rise during the index intervention was 537±258 U/l (reference: <80). A DDD-pacemaker (DDD-PM) had to be implanted in 26 pts. (22%) for procedure-related AV conduction problems. A re-intervention for residual or recurrent outflow obstruction (LVOTO) had to be performed in 12 pts. (10%; re-PTSMA: 10 pts.; myectomy: 2 pts). These cases included, at their last follow-up visit 107 pts. (89%) were in functional class I or II. During follow-up (159±33 [range: 122–264] months), 12 pts. (8%) died, of these 6 (4%) from non-cardiac, and 6 (4%) from cardiovascular causes including one sudden death. Furthermore, 4 (3%) ICDs were implanted (1 for secondary, 3 for primary prevention of sudden cardiac death). The most frequent clinical problem was atrial fibrillation which occurred in 27 pts. (23%), and which was refractory to rhythm control attempts in 21 pts. (18%).
Conclusions
The procedure-related DDD-PM rate in this septal ablation cohort including the early learning curve more than doubled the current one. Nevertheless, during ultra long-term follow up a durable clinical improvement was observed with mortality rates around 1%/year, nearly equivalent to that of 0.8% observed in normal populations. Atrial fibrillation is a frequent problem in this elderly, formerly obstructive HCM population.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- L Faber
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - S Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - A Batzner
- Juliusspital, Medical Clinic, Wuerzburg, Germany
| | - H Seggewiss
- Juliusspital, Medical Clinic, Wuerzburg, Germany
| |
Collapse
|
9
|
Batzner A, Pfeiffer B, Seggewiss H. P690Identification of septal collaterals to prevent alcohol misplacement in percutaneous septal ablation of HOCM. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Batzner
- Klinikum Würzburg Mitte, Standort Juliusspital, Medizinische Klinik - Kardiologie und internistische Intensivmedizin, Würzburg, Germany
| | - B Pfeiffer
- Leopoldina Hospital, Schweinfurt, Germany
| | - H Seggewiss
- Klinikum Würzburg Mitte, Standort Juliusspital, Medizinische Klinik - Kardiologie und internistische Intensivmedizin, Würzburg, Germany
| |
Collapse
|
10
|
Liebregts M, Faber L, Jensen M, Vriesendorp P, Januska J, Krejci J, Hansen P, Seggewiss H, Horstkotte D, Adlova R, Bundgaard H, Ten Berg J, Veselka J. P2313Outcome of alcohol septal ablation in younger patients with obstructive hypertrophic cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Tojino AL, Laymouna R, Monteiro A, Velcea A, Almeida Morais L, Enzan N, Wang TL, Kemaloglu Oz TUĞBA, Mursa A, Pfeiffer B, Tomaszewski M, Cuddy S, Giubertoni A, Rojo Prieto N, Ruivo C, Saito M, Dorobantu DM, Kemal HS, Sta Maria HF, Tiongco RP, Elsharkawy E, Morsy Y, Elshafei M, Elgowelly M, Almaghraby A, Branco L, Agapito A, Sousa L, Galrinho A, Pinto F, Rio P, Rosa S, Portugal G, Ferreira R, Mihaila S, Patrascu N, Adronic A, Cinteza M, Vinereanu D, Fiarresga A, Cacela D, Sousa L, Galrinho A, Branco L, Rodrigues R, Banazol N, Ferreira L, Ferreira R, Tsutsumi T, Matsumoto T, Uchida T, Yamada A, Hsiung MC, Eren MEHMET, Zarma L, Popescu BA, Ginghina C, Jurcut R, Neugebauer A, Rigopoulos A, Seggewiss H, Czekajska-Chehab E, Pietura R, Tomaszewski A, Sullivan V, Cosgrave J, Daly C, Murphy R, Zanaboni J, Gravellone M, Piccinino C, Marino PN, Lezcano Pertejo C, Hernandez Diez C, Alvarez Roy L, Martinez Paz E, Ascencio Lemus MG, Lopez Benito M, Fernandez-Vazquez F, Martin Gutierrez E, Castano Ruiz M, Guardado J, Santos L, Montenegro Sa F, Saraiva F, Correia J, Morais J, Mahara K, Ueda T, Ishii T, Hamamichi Y, Katsuragi S, Enache R, Platon P, Vladaia A, Popescu BA, Ginghina CD, Gunsel A, Cerit L, Duygu HS. Clinical Case Poster session 2P608Infective endocarditis in an adult female with bicuspid aortic valve, hypertrophic cardiomyopathy and amyopathic dermatomyositisP609Left ventricular massP610A rare case of mitral stenosis - Shones syndromeP611The added value of three-dimensional echocardiography in the late diagnosis of a pacemaker complication in a patient with severe congestive heart failureP612Percutaneous paravalvular leak closure - procedure pitfallsP613A case of late left ventricular pseudoaneurysm after aortic valve replacement for infective endocarditis.P614Pseudoaneurysm of right ventricle and acute heart failure caused by prosthetic aortic valve endocarditisP615A misclassification of pulmonary stenosis severity during pregnancyP616A problematic case of left ventricular hypertrophyP617High variability of dynamic obstruction in a patient with hypertrophic obstructive cardiomyopathy and tako-tsubo-cardiomyopathyP618Arterio-venous pulmonary fistula in patient after cerebral strokeP619Rapid myocardial calcification in acute sepsisP620Acute right heart failure after delivery in patient with new-diagnosed pulmonary arterial hypertensionP621When the right ventricle plays hide-and-seekP622Adult congenital heart disease: when what grows wrong goes wrongP623Prenatal diagnosis of mixed type total anomalous pulmonary venous connection in aspleniaP624Uncorrected single ventricle in an adult patient: do coexisting valvular abnormalities matter?P625Ventricular septal aneurysm associated with bicuspid aorta: a case report. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
12
|
Mihalcea D, Bergler-Klein J, Grogan M, Pagourelias E, Faber L, Ciampi Q, Debonnaire P, Saberniak J, Florescu M, Vladareanu AM, Mihaila S, Vinereanu D, Spannbauer A, Zlabinger K, Macejovska D, Maurer G, Gyongyosi M, Scott C, Lin G, Klarich K, Miller W, Dispenzieri A, Mirea OC, Duchenne J, Vovas G, Van Aelst L, Claus P, Van Cleemput J, Delforge M, Bogaert J, Voigt JU, Burghardt A, Seggewiss H, Van Buuren F, Horstkotte D, Olivotto I, Gardini C, Monserrat L, Peteiro J, Lopes L, Cotrim C, Losi MA, Lazzeroni DE, Picano E, Joyce E, Van Den Brink OVW, Bax JJ, Delgado V, Ajmone Marsan N, Leren IS, Haland TF, Hopp E, Edvardsen T, Haugaa KH. Rapid Fire Abstract session: new insights in cardiomyopthies434The role of 4D echocardiography and cardiac biomarkers for early detection of chemotherapy induced cardiotoxicity in nonHodgkin lymphoma patients435Identification of proto-oncogenes and genes responsible for myocardial fibrosis and diastolic dysfunction after anticancer treatment under experimental conditions436Wild type transthyretin cardiac amyloidosis: clinical characteristics, echocardiographic findings, and predictors of outcome437A novel echocardiographic index for detection of cardiac amyloidosis.438Left ventricular outflow obstruction is a treatable feature rather than a risk marker in patients with hypertrophic cardiomyopathy439The international stress echo registry in hypertrophic cardiomyopathy440Value of left atrial size and function to risk stratify for new onset atrial fibrillation in hypertrophic cardiomyopathy441Right ventricle ejection fraction by cardiac resonance imaging is superior in discrimination between early phase ARVC and right ventricular outflow tract ventricular tachycardia. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
13
|
Rigopoulos AG, Daci S, Pfeiffer B, Neugebauer A, Seggewiss H. Ventricular arrhythmias after alcohol septal ablation in high-risk patients with hypertrophic obstructive cardiomyopathy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
14
|
Rigopoulos AG, Pfeiffer B, Seggewiss H. Serial septal branch assessment in hypertrophic obstructive cardiomyopathy: New echocardiographic contrast agent for alcohol septal ablation. Herz 2013; 39:219-21. [PMID: 23588605 DOI: 10.1007/s00059-013-3794-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/05/2013] [Accepted: 02/27/2013] [Indexed: 12/01/2022]
Affiliation(s)
- A G Rigopoulos
- Medizinische Klinik 1, Leopoldina Krankenhaus Schweinfurt, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany,
| | | | | |
Collapse
|
15
|
Altman M, Bergerot C, Thibault H, Aussoleil A, Skuldadt Davidsen E, Barthelet M, Derumeaux GA, Grapsa J, Zimbarra Cabrita I, Afilalo J, Paschou S, Dawson D, Durighel G, O'regan D, Howard L, Gibbs J, Nihoyannopoulos P, Morenate Navio M, Mesa Rubio M, Ortega MD, Ruiz Ortiz M, Castillo Bernal F, Del Pino CL, Toledano F, Alvarez-Ossorio MP, Ojeda Pineda S, Lezo Cruz-Conde JSD, Jasaityte R, Claus P, Teske A, Herbots L, Verheyden B, Rademakers F, D'hooge J, Tocchetti CG, Coppola C, Rea D, Quintavalle C, Guarino L, Castaldo N, De Lorenzo C, Condorelli G, Arra C, Maurea N, Voilliot D, Huttin O, Camara Y, Djaballah W, Carillo S, Zinzius P, Sellal J, Angioi M, Juilliere Y, Selton-Suty C, Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Szwench E, Rybicka J, Januszewicz A, Hoffman P, Jurado Roman A, De Dios Perez S, De Nicolas JMM, Diaz Anton B, Rubio Alonso B, Martin Asenjo R, Mayordomo Gomez S, Villagraz Tecedor L, Blazquez L, De Meneses RT, Bernard A, Hernandez AI, Reynaud A, Lerclercq C, Daubert J, Donal E, Arjan Singh R, Sivarani S, Lim S, Azman W, Almeida M, Cardim N, Fonseca V, Carmelo V, Santos S, Santos T, Toste J, Kosmala W, Orda A, Karolko B, Mysiak A, Przewlocka-Kosmala M, Farsalinos K, Tsiapras D, Kyrzopoulos S, Avramidou E, Vassilopoulou D, Voudris V, Hayrapetyan H, Adamyan K, Jurado Roman A, De Dios Perez S, Rubio Alonso B, De Nicolas JMM, Diaz Anton B, Martin Asenjo R, Montero Cabezas J, Granda Nistal C, Garcia Aranda B, Sanchez Sanchez V, Sestito A, Lamendola P, Di Franco A, Lauria C, Lanza G, Kukucka M, Unbehaun A, Buz S, Mladenow A, Kuppe H, Pasic M, Habazettl H, Gemma D, Montoro Lopez N, De Celix MGR, Lopez Fernandez T, De Torres Alba F, Del Valle DI, Ramirez U, Mesa J, Moreno Yanguela M, Lopez Sendon J, Eveborn GW, Schirmer H, Lunde P, Heggelund G, Rasmussen K, Wang Z, Lasota B, Mizia-Stec K, Mizia M, Chmiel A, Adamczyk T, Chudek J, Gasior Z, Venkatesh A, Johnson J, Sahlen A, Brodin L, Winter R, Shahgaldi K, Manouras A, Valbuena S, Iniesta A, Lopez T, De Torres F, Salinas P, Garcia S, Ramirez U, Mesa J, Moreno M, Lopez-Sendon J, Lebid I, Kobets T, Kuzmenko T, Katsanos S, Yiu K, Clavel M, Nina Ajmone N, Van Der Kley F, Rodes Cabau J, Schalij M, Bax J, Pibarot P, Delgado V, Fusini L, Tamborini G, Muratori M, Gripari P, Marsan N, Cefalu' C, Ewe S, Maffessanti F, Delgado V, Pepi M, Hasselberg N, Haugaa K, Petri H, Berge K, Leren T, Bundgaard H, Edvardsen T, Ancona R, Comenale Pinto S, Caso P, Coppola M, Rapisarda O, Cavallaro C, Vecchione F, D'onofrio A, Calabro' R, Rimbas R, Mihaila S, Enescu O, Patrascu N, Dragoi R, Rimbas M, Pop C, Vinereanu D, Gustafsson S, Morner S, Gronlund C, Suhr O, Lindqvist P, Di Bella G, Zito C, Minutoli F, Madaffari A, Cusma Piccione M, Mazzeo A, Massimo R, Pasquale M, Vita G, Carerj S, Rangel I, Goncalves A, Sousa C, Correia A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Pfeiffer B, Rigopoulos A, Seggewiss H, Alvarez Fuente M, Sainz Costa T, Medrano C, Navarro M, Blazquez Gamero D, Ramos J, Mellado M, De Jose M, Munoz M, Maroto E, Gargani L, Gosciniak P, Pratali L, Agoston G, Bruni C, Guiducci S, Matucci Cerinic M, Varga A, Sicari R, Picano E, Yiu K, Zhao C, Mei M, Yeung C, Siu C, Tse H, Florescu M, Enescu O, Magda L, Mincu R, Vinereanu D, Daha I, Stanescu CM, Chirila L, Baicus C, Vlase A, Dan G, Montoro Lopez M, Florez Gomez R, Alonso Ladreda A, Itziar Soto C, Rios Blanco J, Gemma D, De Torres Alba F, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, Lichodziejewska B, Kurnicka K, Goliszek S, Kostrubiec M, Dzikowska-Diduch O, Ciurzynski M, Labyk A, Krupa M, Palczewski P, Pruszczyk P, De Sousa CC, Rangel I, Correia A, Martins E, Vigario A, Pinho T, Silva Cardoso J, Goncalves A, Macedo F, Maciel M, Park SJ, Song JE, Lee YJ, Ha MR, Chang SA, Choi JO, Lee SC, Park S, Oh J, Van De Bruaene A, De Meester P, Buys R, Vanhees L, Delcroix M, Voigt J, Budts W, Blundo A, Buccheri S, Monte IP, Leggio S, Tamburino C, Sotaquira M, Fusini L, Maffessanti F, Pepi M, Lang R, Caiani E, Floria M, De Roy L, Xhaet O, Blommaert D, Jamart J, Gerard M, Deceuninck O, Marchandise B, Seldrum S, Schroeder E, Unsworth B, Sohaib S, Kulwant-Kaur K, Malcolme-Lawes L, Kanagaratnam P, Malik I, Ren B, Mulder H, Haak A, Van Stralen M, Szili-Torok T, Pluim J, Geleijnse M, Bosch J, Baglini R, Amaducci A, D'ancona G, Van Den Oord S, Akkus Z, Bosch J, Ten Kate G, Renaud G, Sijbrands E, De Jong N, Van Der Lugt A, Van Der Steen A, Schinkel A, Bjallmark A, Larsson M, Grishenkov D, Brodin LA, Brismar T, Paradossi G, Sveen KA, Nerdrum T, Hanssen K, Dahl-Jorgensen K, Steine K, Cimino S, Pedrizzetti G, Tonti G, Canali E, Petronilli V, Cicogna F, Arcari L, De Luca L, Iacoboni C, Agati L, Abdel Moneim SS, Eifert Rain S, Bernier M, Bhat G, Hagen M, Bott-Kitslaar D, Castello R, Wilansky S, Pellikka P, Mulvagh S, Delithanasis I, Celutkiene J, Kenny C, Monaghan M, Park W, Hong G, Son J, Lee S, Kim U, Park J, Shin D, Kim Y, Toutouzas K, Drakopoulou M, Aggeli C, Felekos I, Nikolaou C, Synetos A, Stathogiannis K, Tsiamis E, Siores E, Stefanadis C, Plicht B, Kahlert P, Grave T, Buck T, Konorza T, Gursoy M, Gokdeniz T, Astarcioglu M, Bayram Z, Cakal B, Karakoyun S, Kalcik M, Acar R, Kahveci G, Ozkan M, Maffessanti F, Tamborini G, Tsang W, Weinert L, Gripari P, Fusini L, Muratori M, Caiani E, Lang R, Pepi M, Yurdakul S, Avci B, Sahin S, Dilekci B, Aytekin S, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Rapisarda O, Calabro' R, Hascoet S, Martin R, Dulac Y, Peyre M, Benzouid C, Hadeed K, Acar P, Celutkiene J, Zakarkaite D, Skorniakov V, Zvironaite V, Grabauskiene V, Burca J, Ciparyte L, Laucevicius A, Di Salvo G, Rea A, D'aiello A, Del Gaizo F, Pergola V, D'andrea A, Caso P, Pacileo G, Calabro R, Russo M, Dedobbeleer C, Hadefi A, Naeije R, Unger P, Mornos C, Cozma D, Ionac A, Mornos A, Valcovici M, Pescariu S, Petrescu L, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Stoerk S, Knop S, Ertl G, Bijnens B, Weidemann F, De Knegt M, Biering-Sorensen T, Sogaard P, Sivertsen J, Jensen J, Mogelvang R, Dedobbeleer C, Hadefi A, Unger P, Naeije R, Lam W, Tang M, Chan K, Yang Y, Fang F, Sun J, Yu C, Lam Y, Panoulas V, Sulemane S, Bratsas A, Konstantinou K, Nihoyannopoulos P, Cimino S, Canali E, Petronilli V, Cicogna F, Arcari L, De Luca L, Francone M, Iacoboni C, Agati L, Schau T, Seifert M, Ridjab D, Schoep M, Gottwald M, Neuss M, Meyhoefer J, Zaenker M, Butter C, Tarr A, Stoebe S, Pfeiffer D, Hagendorff A, Maret E, Ahlander BM, Bjorklund PG, Engvall J, Staskiewicz G, Czekajska-Chehab E, Adamczyk P, Siek E, Przybylski P, Maciejewski R, Drop A, Jimenez Rubio C, Isasti Aizpurua G, Miralles Ibarra J, Al-Mallah M, Somg T, Alam S, Chattahi J, Zweig B, Dhanalakota K, Boedeker S, Ananthasubramaniam K, Park C, March K, Jones S, Mayet J, Tillin T, Chaturvedi N, Hughes A, Hamodraka E, Kallistratos E, Karamanou A, Tsoukas T, Mavropoulos D, Kouremenos N, Zaharopoulou I, Nikolaidis N, Kremastinos D, Manolis A, Loboz-Rudnicka M, Jaroch J, Bociaga Z, Kruszynska E, Ciecierzynska B, Dziuba M, Dudek K, Uchmanowicz I, Loboz-Grudzien K, Silva D, Magalhaes A, Jorge C, Cortez-Dias N, Carrilho-Ferreira P, Silva Marques J, Portela I, Pascoa C, Nunes Diogo A, Brito D, Roosens B, Bala G, Droogmans S, Hostens J, Somja J, Delvenne E, Schiettecatte J, Lahoutte T, Van Camp G, Cosyns B. Poster Session: Right ventricular systolic function. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
16
|
Cikes M, Tong L, Jasaityte R, Hamilton J, Sutherland G, D'hooge J, Yurdakul S, Oner F, Avci BK, Sahin S, Direskeneli H, Aytekin S, Fang F, Chan A, Zhang Q, Sanderson J, Kwong J, Yu C, Zaidi A, Raju H, Ghani S, Gati S, Cox A, Sheikh N, Sharma R, Sharma S, Kutty S, Kottam A, Padiyath A, Gao S, Drvol L, Lof J, Li L, Rangamani S, Danford D, Kuehne T, Rosner A, Avenarius D, Malm S, Iqbal A, Baltabaeva A, Schirmer H, Bijnens B, Myrmel T, Magalhaes A, Silva Marques J, Martins S, Carrilho Ferreira P, Jorge C, Silva D, Placido R, Goncalves S, Almeida A, Nunes Diogo A, Poulidakis E, Aggeli C, Sideris S, Dilaveris P, Gatzoulis K, Felekos I, Koutagiar I, Sfendouraki E, Roussakis G, Stefanadis C, Zhang Q, Sun J, Gao R, Feng Y, Liu X, Sheng W, Liu F, Yu C, Hallioglu O, Citirik D, Buyukakilli B, Ozeren M, Gurgul S, Tasdelen B, Rodriguez Lopez A, Rodriguez Lopez A, Garcia Cuenllas L, Garcia Cuenllas L, Medrano C, Medrano C, Granja S, Granja S, Marin C, Marin C, Maroto E, Maroto E, Alvarez T, Alvarez T, Ballesteros F, Ballesteros F, Camino M, Camino M, Centeno M, Centeno M, Alraies M, Aljaroudi W, Halley C, Rodriguez L, Grimm R, Thomas J, Jaber W, Knight D, Coghlan J, Muthurangu V, Grasso A, Toumpanakis C, Caplin M, Taylor A, Davar J, Mohlkert LA, Halvorsen C, Hallberg J, Sjoberg G, Norman M, Cameli M, Losito M, Lisi M, Natali B, Massoni A, Maccherini M, Chiavarelli M, Massetti M, Mondillo S, Sljivic A, Stojcevski B, Celic V, Pencic B, Majstorovic A, Cosic Z, Backovic S, Ilic-Djordjevic I, Muraru D, Gripari P, Esposito R, Tamborini G, Galderisi M, Ermacora D, Maffessanti F, Santoro C, Pepi M, Badano L, Bombardini T, Cini D, Picano E, Shahgaldi K, Gunyeli E, Sahlen A, Manouras A, Winter R, Banovic M, Vukcevic V, Ostojic M, Markovic Z, Mladenovic A, Trifunovic D, Stojkovic S, Bacic D, Dedovic D, Seferovic P, Huttin O, Coulibaly S, Mercy M, Schwartz J, Zinzius P, Sellal J, Popovic B, Marie P, Juilliere Y, Selton-Suty C, Gurzun MM, Ionescu A, Bahlay B, Jones G, Rimbas R, Enescu O, Mihaila S, Ciobanu A, Vinereanu D, Vlasseros I, Koumoulidis A, Tousoulis D, Veioglanis S, Avgeropoulou A, Katsi V, Stefanadis C, Kallikazaros I, Kiviniemi T, Ylitalo A, Airaksinen K, Lehtinen T, Saraste A, Pietila M, Karjalainen P, Trifunovic D, Ostojic M, Stankovic S, Vujisic-Tesic B, Petrovic M, Banovic M, Boricic M, Draganic G, Petrovic M, Stepanovic J, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Dekleva M, Stevanovic A, Kleut M, Suzic Lazic J, Markovic Nikolic N, Akhunova S, Saifullina G, Sadykov A, Loudon M, D'arcy J, Arnold L, Reynolds R, Mabbet C, Prendergast B, Dahl J, Videbaek L, Poulsen M, Rudbaek T, Pellikka P, Rasmussen L, Moller J, Lowery C, Frenneaux M, Dawson D, Dwivedi G, Singh S, Rudd A, Mahadevan D, Srinivasan J, Jiminez D, Sahinarslan A, Vecchio F, Maccarthy P, Wendler O, Monaghan M, Harimura Y, Seo Y, Ishizu T, Noguchi Y, Aonuma K, Urdaniz MM, Palomares JFR, Rius JB, Surribas IB, Tura GT, Garcia-Moreno LG, Alujas TG, Masip AE, Mas PT, Dorado DG, Meimoun P, Germain A, Clerc J, Elmkies F, Zemir H, Luycx-Bore A, Nasr GM, Erraki A, Dulgheru R, Magne J, Capoulade R, Elhonsali Z, Pierard LA, Pibarot P, Lancellotti P, Wrideier S, Butz T, Schilling I, Gkiouras G, Sasko B, Van Bracht M, Prull M, Trappe HJ, Castillo Bernal F, Mesa Rubio M, Ruiz Ortiz M, Delgado Ortega M, Morenate Navio M, Baeza Garzon M, Del Pino ML, Toledano Delgado F, Mazuelos F, Suarez de Lezo Herreros de Tejada J, Prinz C, Schumann M, Burghardt A, Seggewiss H, Oldenburg O, Horstkotte D, Faber L, Bistola V, Banner N, Hedger M, Simon A, Rahman Haley S, Baltabaeva A, Adamyan K, Tumasyan LR, Chilingaryan A, Makavos G, Kouris N, Kostopoulos V, Stamatelatou M, Damaskos D, Kartsagoulis E, Olympios C, Sade L, Eroglu S, Bircan A, Pirat B, Sezgin A, Aydinalp A, Muderrisoglu H, Sargento L, Satendra M, Sousa C, Longo S, Lousada N, Dos Reis RP, Kuznetsov V, Krinochkin D, Gapon L, Vershinina A, Shurkevich N, Bessonova M, Yaroslavskaya E, Kolunin G, Sargento L, Satendra M, Sousa C, Lousada N, Dos Reis RP, Azevedo O, Lourenco M, Machado I, Guardado J, Medeiros R, Pereira A, Quelhas I, Lourenco A, Duman D, Sargin F, Kilicaslan B, Inan A, Ozgunes N, Goktas P, Ikonomidis I, Tzortzis S, Paraskevaidis I, Andreadou I, Katseli C, Katsimbri P, Papadakis I, Pavlidis G, Anastasiou-Nana M, Lekakis J, Charalampopoulos A, Howard L, Davies R, Gin-Sing W, Tzoulaki I, Grapsa I, Gibbs J, Dobson RA, Cuthbertson DJ, Burgess M, Lichodziejewska B, Kurnicka K, Goliszek S, Kostrubiec M, Dzikowska-Diduch O, Ciurzynski M, Krupa M, Grudzka K, Palczewski P, Pruszczyk P, Mansencal N, Marcadet D, Montalvan B, Dubourg O, Matveeva N, Nartsissova G, Chernjavskiy A, Eicher JC, Berthier S, Lorcerie B, Philip JL, Wolf JE, Wiesen P, Ledoux D, Massion P, Piret S, Canivet JL, Cusma-Piccione M, Zito C, Imbalzano E, Saitta A, Donato D, Madaffari A, Luzza G, Pipitone V, Tripodi R, Carerj S, Bombardini T, Gherardi S, Arpesella G, Maccherini M, Serra W, Del Bene R, Sicari R, Picano E, Al-Mallah M, Ananthasubramaniam K, Alam M, Chattahi J, Zweig B, Boedeker S, Song T, Khoo J, Davies J, Ang KL, Galinanes M, Chin D, Papamichael ND, Karassavidou D, Mpougialkli M, Antoniou S, Giannitsi S, Chachalos S, Gouva C, Naka K, Katopodis K, Michalis L, Tsang W, Cui V, Ionasec R, Takeuchi M, Houle H, Weinert L, Roberson D, Lang R, Altman M, Aussoleil A, Bergerot C, Sibellas F, Bonnefoy-Cudraz E, Derumeaux GA, Thibault H, Mohamed A, Omran A, Hussein M, Shahgaldi K, Gunyeli E, Sahlen A, Manouras A, Winter R, Squeri A, Binno S, Ferdenzi E, Reverberi C, Baldelli M, Barbieri A, Iaccarino D, Naldi M, Bosi S, Kalinowski M, Szulik M, Streb W, Stabryla J, Nowak J, Rybus-Kalinowska B, Kukulski T, Kalarus Z, Ouss A, Riezebos R, Nestaas E, Skranes J, Stoylen A, Brunvand L, Fugelseth D, Magalhaes A, Silva Marques J, Martins S, Carrilho Ferreira P, Placido R, Jorge C, Silva D, Goncalves S, Almeida A, Nunes Diogo A, Nagy A, Kovats T, Apor A, Nagy A, Vago H, Toth A, Toth M, Merkely B, Ranjbar S, Karvandi M, Hassantash S, Da Silva SG, Marin C, Rodriguez A, Marcos C, Rodriguez-Ogando A, Maroto E, Medrano C, Del Valle DI, Lopez-Fernandez T, Gemma D, Gomez-Rubin M, De Torres F, Feliu J, Canales M, Buno A, Ramirez E, Lopez-Sendon J, Magalhaes A, Silva Marques J, Martins S, Placido R, Silva D, Jorge C, Calisto C, Goncalves S, Almeida A, Nunes Diogo A, Jorge C, Cortez-Dias N, Goncalves S, Ribeiro S, Santos L, Silva D, Barreiros C, Bernardes A, Carpinteiro L, Sousa J, Kim SH, Choi W, Chidambaram S, Arunkumar R, Venkatesan S, Gnanavelu G, Dhandapani V, Ravi M, Karthikeyan G, Meenakshi K, Muthukumar D, Swaminathan N, Vitarelli A, Barilla F, Capotosto L, Truscelli G, Dettori O, Caranci F, D-Angeli I, De Maio M, De Cicco V, Bruno P, Doesch C, Sueselbeck T, Haghi D, Streitner F, Borggrefe M, Papavassiliu T, Laser K, Schaefer F, Fischer M, Habash S, Degener F, Moysich A, Haas N, Kececioglu D, Burchert W, Koerperich H, Dwivedi G, Al-Shehri H, Dekemp R, Ali I, Alghamdi A, Klein R, Scullion A, Beanlands R, Ruddy T, Chow B, Lipiec P, Szymczyk E, Michalski B, Wozniakowski B, Rotkiewicz A, Stefanczyk L, Szymczyk K, Kasprzak J, Angelov A, Yotov Y, Mircheva L, Kisheva A, Kunchev O, Ikonomidis I, Tsantes A, Triantafyllidi H, Tzortzis S, Dima K, Trivilou P, Papadopoulos C, Travlou A, Anastasiou-Nana M, Lekakis J, Bader R, Agoston-Coldea L, Lupu S, Mocan T, Loegstrup B, Hofsten D, Christophersen T, Moller J, Bjerre M, Flyvbjerg A, Botker H, Egstrup K, Park Y, Choi J, Yun K, Lee S, Han D, Kim J, Kim J, Kim J, Chun K. Poster Session Wednesday 5 December all day Display * Determinants of left ventricular performance. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
17
|
Welge D, Seggewiss H, Fassbender D, Schmidt HK, Horstkotte D, Faber L. [Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy ]. Dtsch Med Wochenschr 2008; 133:1949-54. [PMID: 18798130 DOI: 10.1055/s-0028-1085601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Persisting disabling symptoms despite optimal medical treatment in patients with hypertrophic cardiomyopathy and significant outflow tract obstruction prompt surgical or interventional therapy targeted at relief of obstruction. While surgical treatment was introduced more than 40 years ago, there are only a few data on the long-term results of percutaneous septal ablation. This study gives the results of a large number of patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal ablation in our institution. PATIENTS AND METHODS 347 patients (156 females, 191 males, 54 +/- 15 years) in NYHA functional class III or IV, or in class II but with evidence of more severe limitation on exercise testing, underwent percutaneous transluminal septal myocardial ablation (PTSMA). Mortality and morbidity, as well as clinical and echocardiographic parameters were assessed during follow-up, either at our institution, or by the referring cardiologist. RESULTS During an average follow-up of 58 +/- 35 months the overall mortality was about 1,8 % per year, with a cardiovascular-related mortality of about 1 % per year. 8 % of patients needed a second procedure. A significant and sustained improvement of symptoms (89 % patients were in NYHA class I or II a follow-up) and obstruction were demonstrated (74 % of patients were free from obstruction at rest, 60 % did not exhibit provokable gradients). Supraventricular arrhythmias, especially atrial fibrillation, were observed in 12 % of patients. CONCLUSION Percutaneous septal ablation provides significant and sustained beneficial effects on symptoms and echocardiographic variables, without evidence of an excess mortality. But independently of the clinical success of the procedure persistence of the underlying structural heart disease should be kept in mind. Periodic re-evaluation is mandatory to identify and treat high-risk patients.
Collapse
Affiliation(s)
- D Welge
- Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | | | | | | | | | | |
Collapse
|
18
|
Seggewiss H, Rigopoulos A, Welge D, Ziemssen P, Faber L. Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy. Clin Res Cardiol 2007; 96:856-63. [PMID: 17891517 DOI: 10.1007/s00392-007-0579-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Accepted: 04/11/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the longterm follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in a large patient cohort. BACKGROUND PTSMA by alcohol injection into septal branches has shown good acute and short-term results in symptomatic patients with hypertrophic obstructive cardiomyopathy. METHODS A total of 100 consecutive symptomatic (NYHA class 2.8 +/- 0.6) patients underwent PTSMA. All patients had clinical and non-invasive follow-up at 3 months, 1 year, and annually up to 8 years. RESULTS One patient died at day 2 after intervention due to fulminant pulmonary embolism following deep venous thrombosis, and eight patients required a permanent DDD-pacemaker due to post-interventional complete heart block. Acute reduction of the left ventricular outflow tract gradient was achieved from 76 +/- 37 to 19 +/- 21 mmHg at rest, from 104 +/- 34 to 43 +/- 31 mmHg during Valsalva maneuver, and from 146 +/- 45 to 59 +/- 42 mmHg post extrasystole (p < 0.0001, each). During follow-up (mean follow-up time: 58 +/- 14 months), three additional patients died (sudden death at 48 months, non-cardiac death at 49 months and stroke-related death at 60 months after the index procedure). All living patients showed clinical improvement to NYHA-class 1.4 +/- 0.6 (after 3 months, n = 99), 1.5 +/- 0.6 (after 1 year, n = 99), and 1.6 +/- 0.7 at final follow-up (n = 96; p < 0.0001, each). Non-invasive follow-up studies documented ongoing outflow tract gradient reduction, decrease of septal and left ventricular posterior wall thickness, and improvement of exercise capacity. CONCLUSIONS PTSMA is an effective treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy. Follow-up showed ongoing hemodynamic and clinical improvement without increased mortality and morbidity.
Collapse
Affiliation(s)
- H Seggewiss
- Medizinische Klinik 1, Leopoldina-Krankenhaus, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany.
| | | | | | | | | |
Collapse
|
19
|
Faber L, Welge D, Fassbender D, Schmidt HK, Horstkotte D, Seggewiss H. One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response. Clin Res Cardiol 2007; 96:864-73. [PMID: 17891518 DOI: 10.1007/s00392-007-0578-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 04/25/2007] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to analyze hemodynamic and clinical outcome in a cohort of 312 patients who were followed up over a period of 12 months after alcohol septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). METHODS AND RESULTS PTSMA was intended in 337 patients with HOCM (mean age: 54+/-15 years), with 312 procedures completed by injection of 2.8+/-1.2 ml of alcohol. In 25 patients (8%) the intervention was aborted, mostly because of contrast echocardiographic findings. In the 312 patients who received alcohol, permanent pacing was necessary in 22 cases (7%); and in-hospital mortality was 1.3% (four patients). During follow-up, contact to six patients (2%) was lost, and three additional patients (1%) died. The 299 patients who either underwent non-invasive reassessment in our institution or transmitted followup data from their local physician formed the study population. Improvement in symptoms was reported by 272 patients (91%). Mean NYHA functional class was reduced from 2.9+/-0.4 to 1.5+/-0.7 (p<0.0001) along with a gradient reduction (echo-Doppler) from 59+/-32 to 8+/-15 mmHg at rest, and from 120+/-42 to 28+/-32 mmHg with provocation (p<0.0001 each). Exercise capacity improved from 94+/-51 to 119+/-40 watts (p=0.001), and peak oxygen consumption from 18+/-4 to 21+/-6 ml/ kg/min (p=0.01). Younger age and higher outflow gradients at baseline and immediately after intervention were associated with a less favorable hemodynamic outcome. The degree of limitation of exercise capacity at baseline was the only predictor of symptomatic improvement. CONCLUSIONS Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. In contrast to a previous study, in this cohort of 312 patients there was no association between post-interventional enzyme release and hemodynamic success. Younger patients with high baseline gradients, however, tended to have a less favorable hemodynamic outcome with higher residual gradients.
Collapse
Affiliation(s)
- L Faber
- Department of Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
| | | | | | | | | | | |
Collapse
|
20
|
Zahn R, Ischinger T, Hochadel M, Mark B, Zeymer U, Jung J, Schramm A, Hauptmann KE, Seggewiss H, Janicke I, Mudra H, Senges J. Glycoprotein IIb/IIIa antagonists during carotid artery stenting:. Clin Res Cardiol 2007; 96:730-7. [PMID: 17593309 DOI: 10.1007/s00392-007-0551-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Accepted: 05/07/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Glycoprotein II b/IIIa antagonists (GPII b/IIIa-A) lower the periprocedural rate of ischemic events during high risk percutaneous coronary interventions. Their clinical impact on carotid artery stenting (CAS) remains to be determined. METHODS We analyzed data from the Carotid Artery Stent (CAS) Registry. RESULTS From 01/ 2000 to 06/2005 1322 CAS interventions were registered. In 94 (7.1%) procedures a GPII b/IIIa-A was used: abciximab in 8 cases (8.6%), tirofiban in 53 cases (57%) and eptifibatide in 32 cases (34.4%). The use of a GPII b/IIIa-A during CAS decreased significantly over time: from 17.6% in 2000 to 3% in 2005, p for trend <0.0001. The mean use of a GPII b/IIIa-A at the hospitals was 5.2%. More than 50% of the hospitals never used a GPII b/IIIa-A. There were no significant differences in baseline characteristics and concomitant diseases in CAS patients treated with GPII b/IIIa-A compared to those without GPII b/IIIa-A. A bilateral intervention was performed more often in patients treated with GPII b/IIIa-A (2.1 vs 0.2%, p = 0.04), a thrombus was more often visible (27 vs 12.4%, p <0.001) and an ulcer more frequently diagnosed (50 vs 37.5%, p = 0.03). There was no significant difference in the combined death or stroke rate between the two groups (5.3 vs 3.0%, p = 0.22, OR = 1.81, 95% CI: 0.69-4.72), which was confirmed by logistic regression analysis after adjusting for possible confounders (OR = 1.67, 95% CI: 0.62-4.46, p = 0.31). CONCLUSIONS Our data neither demonstrate a significant benefit nor a significant risk with the use of GPIIb/IIIa-A during CAS. However, only an adequately sized randomized controlled clinical trial could establish the real value of GPII b/IIIa-A during CAS. Until then, considering the potential increase in cerebral hemorrhage, we should not use GPII b/ IIIa-A routinely during CAS.
Collapse
Affiliation(s)
- R Zahn
- Kardiologie/Angiologie/Internistische Intensivmedizin, Klinikum Nürnberg, Breslauer Strasse 201, 90471 Nürnberg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Faber L, Seggewiss H, Gietzen FH, Kuhn H, Boekstegers P, Neuhaus L, Seipel L, Horstkotte D. Catheter-based septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: follow-up results of the TASH-registry of the German Cardiac Society. Z Kardiol 2005; 94:516-23. [PMID: 16049653 DOI: 10.1007/s00392-005-0256-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 03/14/2005] [Indexed: 05/03/2023]
Abstract
INTRODUCTION In late 1997, the German Cardiac Society set up a multicenter registry to evaluate the acute and mid-term course of all patients (pts.) treated with septal ablation for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). An analysis of the acute results has already been published. We now report on the mid-term course (3-6 months) of 242 pts. registered through September 1999. RESULTS Follow-up was 92% complete (n=222). During follow-up (mean: 4.9+/-2.3 months), an additional 3 pts. died (in-hospital mortality: 3 pts.). A satisfactory clinical effect was reported by 195 pts. (88%); 27 pts. (12%) remained in NYHA classes III and IV. Overall symptomatic improvement (NYHA class: from 2.8+/-0.7 to 1.7+/-0.7) paralleled the outflow gradient (LVOTG) reduction which was further accentuated as compared with the acute result (Doppler measurement at rest: from 57+/-31 to 25+/-25 mmHg to 20+/-21 mmHg; with provocation: from 107+/-53 to 49+/-40, to 44+/-40 mmHg, p<0.001, resp.). Left atrial (LA) diameter (from 46+/-8 to 44+/-7 mm) and septal thickness (from 20+/-5 to 15+/-5 mm; p<0.001, resp.) were also reduced. Comparing the methods for target vessel selection (i.e., with contrast echo monitoring vs pressurefluoroscopy guidance), at followup clinical improvement and hemodynamic measurements were comparable. CONCLUSION Clinical success can be achieved by septal ablation, both with the echocontrast guided and gradient-fluoroscopy guided method, in 88% of highly symptomatic HOCM pts. At mid-term follow-up, symptoms, left atrial size and septal thickness are reduced, and outflow gradients are further improved as compared to the acute result.
Collapse
Affiliation(s)
- L Faber
- Kardiologische Klinik Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Kuhn H, Seggewiss H, Gietzen FH, Boekstegers P, Neuhaus L, Seipel L. Catheter-based therapy for hypertrophic obstructive cardiomyopathy. ACTA ACUST UNITED AC 2004; 93:23-31. [PMID: 14740238 DOI: 10.1007/s00392-004-1028-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 09/30/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND Registry results of the new catheter-based method in the treatment for HOCM are missing so far. In 1997, the Transcoronary Ablation of Septal Hypertrophy Registry (TASH Registry) was established by the German Cardiac Society (GCS) as a multicenter, national registry of patients with HOCM undergoing the new catheter interventional therapy. This is the report of the in-hospital outcome of patients who underwent the procedure during the first two years of data collection in the registry. METHODS AND RESULTS Information was based on three standard forms for each patient, with a total of 86 variables. Information was collected on an "intention to treat" basis. The TASH Registry includes the establishment of a data base in the data collecting center. Ten centers participated. Enrollment forms were received for 264 patients out of 279 patients registered up to January 2000. There was a history of medical treatment of 3.6+/-3.9 years. The vast majority of patients (91%) were treated in three centers. The Vasalva maneuver and the exercise Doppler echocardiography were used for noninvasive stress testing. Exercise Doppler echocardiography induced a significantly higher augmentation of the baseline gradient (70.1% vs 133.4%; p<0.01). The echo-contrast guided technique was used for the intervention in 50.8% and the pressure angiography guided technique in 49.2%. On the average 2.8+/-1.3 ml of alcohol were injected. Before the procedure, the gradient measured by catheterization was 60.4+/-38.6 mmHg at baseline and 142.7+/-46.2 mmHg following the extrasystolic beat. At the end of the session it was reduced significantly by 75% and 67%. The peak phosphocreatine kinase activity was 482.5+/-246.4 U/L. Major complications occurred in 15.6% including a mortality rate of 1.2% and a permanent pacemaker implantation rate because of total heart block in 9.6%. There was an early in-hospital improvement of dyspnoe corresponding to a significant decrease of NYHA functional class from 2.8+/-0.7 to 1.8+/-0.6 (p<0.001). Similar hemodynamic and clinical benefit was found in patients with and without resting gradient at baseline. CONCLUSION This analysis for the first time gives a comprehensive overview of clinical characteristics, technique, procedural data, in-hospital outcome and complications in a large number of patients with HOCM who were treated by the new catheter-based method and prospectively enrolled in a registry. The results contribute considerably to critical evaluation and validation of the new technique. This analysis supports the catheter-based method to constitute a new therapeutic option for very symptomatic patients, to be effective both in patients with and without intraventricular pressure gradient at rest and to be an alternative to surgical treatment, as has been stated recently.
Collapse
Affiliation(s)
- H Kuhn
- Klinikum Bielefeld-Mitte, Klinik für Kardiologie und Internistische Intensivmedizin, 33604 Bielefeld, Germany.
| | | | | | | | | | | |
Collapse
|
23
|
Faber L, Seggewiss H, Welge D, Fassbender D, Ziemssen P, Schmidt HK, Gleichmann U, Horstkotte D. [Predicting the risk of atrioventricular conduction lesions after percutaneous septal ablation for obstructive hypertrophic cardiomyopathy]. Z Kardiol 2003; 92:39-47. [PMID: 12545300 DOI: 10.1007/s00392-003-0878-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND INTRODUCTION Damage to the AV conduction system is a frequent complication of percutaneous septal ablation (PTSMA) that needs early and reliable identification of those patients (pts.) at risk for complete heart block (CHB) and subsequent pacemaker implantation. METHODS AND RESULTS In the first 39 pts. who underwent PTSMA in 1996, AV conduction recovery needed up to 11 days. One pt. suffered from unexpected CHB after 9 days. Seven pts. who needed a DDD pacemaker (DDD-PM) were compared to those without conduction disturbances. A score was established which identified all DDD-PM candidates retrospectively if they presented with >12 score points. In the following 137 consecutive pts. treated in 1997 and 1998, this score was applied prospectively, and again correctly identified all candidates for a DDD-PM. In addition, a low risk group was identified with <8 score points. From 1999 on, the score was applied in routine clinical decision-making in 120 consecutive pts. with respect to DDD-PM implantation. All low risk pts. (<8 points) remained free from bradycardias, while 2/54 pts. (4%) of the intermediate risk group, and 20/23 pts. (87%) of the high risk group had to undergo DDD-PM implantation. Pts. with a first-degree AV block or those with a right bundle branch block at baseline had no excess risk, while 50% of the pts. with a left bundle branch block (LBBB) needed a DDD-PM. CONCLUSIONS Based on pre-interventional data and careful monitoring of the first 48 hours after PTSMA, identification of pts. at risk for CHB and subsequent DDD-PM implantation seems to be possible. Pts. with a score <8 seem to be at low, those with >12 points at high risk. In the remaining cases watchful waiting with prolonged monitoring may allow AV conduction to recover, thus, reducing the number of unnecessary DDD-PM implantations. In cases with LBBB at baseline, however, implantation of a DDD-PM should be considered first-line therapy.
Collapse
Affiliation(s)
- L Faber
- Kardiologische Klinik, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Seggewiss H. Percutaneous septal ablation: a new treatment for hypertrophic obstructive cardiomyopathy. Neth Heart J 2001; 9:315-317. [PMID: 25696752 PMCID: PMC2499647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
|
25
|
Seggewiss H, Faber L, Ziemssen P, Gleichmann U. [One-year follow-up after echocardiographically-guided percutaneous septal ablation in hypertrophic obstructive cardiomyopathy]. Dtsch Med Wochenschr 2001; 126:424-30. [PMID: 11347004 DOI: 10.1055/s-2001-12731] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion was introduced as a new treatment option in symptomatic patients with hypertrophic obstructive cardiomyopathy. Echocardiographic monitoring of the procedure resulted in improvement of acute results. In this study we analyzed the follow-up after echocardiographic guided septal ablation. METHODS 100 consecutive symptomatic patients (50 men; age 52.7 +/- 15.7 years; NYHA class 2.8 +/- 0.6) underwent percutaneous septal ablation with echocardiographic monitoring. All patients had clinical and non-invasive 3-months and 1 year follow-up. RESULTS Acute reduction of the left ventricular outflow tract gradient was achieved in 99 patients from 76 +/- 37 to 19 +/- 21 mm Hg at rest, from 104 +/- 34 to 43 +/- 31 mm Hg during Valsalva maneuver, and from 146 +/- 45 to 59 +/- 42 mm Hg post extrasystole (p < 0.0001, each). Mean CK rise was 570 +/- 236 U/l. One patient died at day 2 due to fulminant pulmonary embolism following deep venous thrombosis, and 8 patients required a permanent DDD-pacemaker due to postinterventional complete heart block. During follow-up no further patient died. All living 99 patients showed clinical improvement to NYHA-class 1.4 +/- 0.6 after 3 months and 1.5 +/- 0.6 after 1 year (p < 0.0001, each). Non-invasive follow-up studies observed ongoing outflow tract gradient reduction, decrease of septal and left ventricular posterior wall thickness, and improvement of exercise capacity and time. SUMMARY Percutaneous septal ablation is an effective treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy. During one-year follow-up remodeling after induced therapeutic septal infarction resulted in improvement of acute gradient reduction with ongoing symptomatic and objective improvement and without significant complications and side-effects.
Collapse
Affiliation(s)
- H Seggewiss
- Medizinische Klinik I, Leopoldina-Krankenhaus, Schweinfurt.
| | | | | | | |
Collapse
|
26
|
Abstract
Since the early 1960s, surgical myotomy-myectomy has been the standard treatment for patients with drug-refractory symptoms due to hypertrophic cardiomyopathy and dynamic outflow tract obstruction. Comparable morphologic and functional results can be achieved by percutaneous septal ablation (PTSMA) by alcohol-induced septal branch occlusion. The circumscribed therapeutic myocardial infarction results in widening of the left ventricular outflow tract with consecutive gradient reduction. Follow-up studies show clinical and objective improvement as well as further gradient reduction due to left ventricular remodeling. In this article, an updated review of the latest results of PTSMA is provided.
Collapse
Affiliation(s)
- H Seggewiss
- Medizinische Klinik I, Leopoldina-Krankenhaus, Gustav-Adolf-Strasse 8, 97422, Schweinfurt, Germany.
| |
Collapse
|
27
|
Abstract
AIMS Percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion is a new treatment option in symptomatic patients with hypertrophic cardiomyopathy and subaortic, SAM-associated obstruction. We report on a patient with mid-ventricular obstruction and echocardiographic-guided reduction of septal hypertrophy. METHODS AND RESULTS A 52-year-old woman with NYHA class III and recurrent exercise-induced syncope suffered from hypertrophic cardiomyopathy with mid-ventricular obstruction. She had a systolic gradient of 71 mmHg at rest and 153 mmHg post-extrasystole, and diastolic inflow gradient of 20 mmHg. Echo-guided percutaneous transluminal septal myocardial ablation with occlusion of the fourth septal branch resulted in acute reduction and final elimination of systolic, as well as diastolic resting and provocable gradients. Complications were not seen. At 3 months' follow-up the patient was asymptomatic and without further syncopes. CONCLUSIONS Echocardiographic-guided percutaneous transluminal septal myocardial ablation is able to reduce gradients in hypertrophic cardiomyopathy and mid-ventricular obstruction with consecutive improvement of symptoms.
Collapse
Affiliation(s)
- H Seggewiss
- Medizinische Klinik, Leopoldine-Krankenhaus, Schweinfurt, Germany
| | | |
Collapse
|
28
|
Faber L, Ziemssen P, Seggewiss H. Targeting percutaneous transluminal septal ablation for hypertrophic obstructive cardiomyopathy by intraprocedural echocardiographic monitoring. J Am Soc Echocardiogr 2000; 13:1074-9. [PMID: 11119274 DOI: 10.1067/mje.2000.108250] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Percutaneous septal ablation has evolved as an alternative to surgery for reducing symptoms and outflow gradients in patients with hypertrophic obstructive cardiomyopathy. Intraprocedural echo-cardiographic imaging can improve clinical and hemodynamic results. Growing experience with this method has additionally shown that threatening necrosis of the myocardium distant from the septal target region can be detected. METHODS AND RESULTS Percutaneous septal ablation was performed in 162 patients (80 women, 82 men; aged 54.1 +/- 15.5 years); 131 of whom were targeted by intraprocedural myocardial contrast echocardiography. In 11 patients (7%), an atypical target vessel or a perfusion area distant from the expected septal target region was detected, leading to a target vessel change. Permanent pacing was necessary in 14 patients (9%). Three patients (2%) died. After 3 months, the mean New York Heart Association functional class was reduced in the returning 159 patients from 2.8 +/- 0.5 to 1.3 +/- 1.0 (P <.0001) along with a gradient reduction from 77 +/- 35 to 12 +/- 22 mm Hg at rest, and from 147 +/- 43 to 44 +/- 45 mm Hg with provocation (P < .0001 each). The main reason for unsatisfactory gradient reduction was suboptimal scar placement in the patients treated before the introduction of intraprocedural myocardial contrast echocardiography. CONCLUSIONS Percutaneous septal ablation is an effective nonsurgical technique for reducing symptoms and outflow gradients in hypertrophic obstructive cardio-myopathy. Echocardiographic guidance adds substantially to safety and efficacy of the procedure and should therefore be considered routinely.
Collapse
Affiliation(s)
- L Faber
- Department of Cardiology, Heart Center NRW, Ruhr-University Bochum, D-32545 Bad Oeynhausen, Germany.
| | | | | |
Collapse
|
29
|
|
30
|
Faber L, Meissner A, Ziemssen P, Seggewiss H. Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: long term follow up of the first series of 25 patients. Heart 2000; 83:326-31. [PMID: 10677415 PMCID: PMC1729336 DOI: 10.1136/heart.83.3.326] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To determine the long term outcome in patients treated with percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM). DESIGN AND SETTING Observational, single centre study. PATIENTS 25 patients (13 women, 12 men, mean (SD) age 54.7 (15.0) years) with drug treatment resistant New York Heart Association (NYHA) class 2.8 (0. 6) symptoms attributed to a high left ventricular outflow gradient (LVOTG) and a coronary artery anatomy suitable for intervention. INTERVENTION PTSMA by injection of 4.1 (2.6) ml of alcohol (96%) into 1.4 (0.6) septal perforator arteries to ablate the hypertrophied interventricular septum. OUTCOME MEASURES During in-hospital follow up, enzyme rise, the frequency of atrioventricular conduction lesions requiring permanent DDD pacing, and in-hospital mortality were assessed. Long term follow up (30 (4) months, range 24-36 months) included symptoms, echocardiographic measurements of left atrial and left ventricular dimensions and function, and LVOTG. RESULTS Mean postinterventional creatine kinase rise was 780 (436) U/l. During PTSMA 13 patents developed total heart block, permanent pacing being necessary in five of them. One 86 year old patient died from ventricular fibrillation associated with intensive treatment (beta mimetic and theophylline) for coexistent severe obstructive airway disease. After three months, three patients underwent re-PTSMA because of a dissatisfactory primary result, leading to LVOTG elimination in all of them. During long term follow up, LVOTG showed sustained reduction (3 (6) mm Hg at rest and 12 (19) mm Hg with provocation) associated with stable symptomatic improvement (NYHA class 1.2 (1.0)) and without significant global left ventricular dilatation. CONCLUSIONS PTSMA is an effective non-surgical technique for reduction of symptoms and LVOTG in HOCM. Prospective, long term observations of larger populations are necessary in order to determine the definitive significance of the procedure.
Collapse
Affiliation(s)
- L Faber
- Department of Cardiology, Heart Center NRW, Ruhr-University of Bochum, Georgstrasser 11, D-32545 Bad Oeynhausen, Germany
| | | | | | | |
Collapse
|
31
|
Abstract
Until the early 1990s, surgical myectomy was the standard treatment for patients with hypertrophic obstructive cardiomyopathy and drug refractory symptoms. In the past few years, the potential therapeutic options have dramatically changed with the introduction of DDD-pacemaker implantation and percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion. The circumscribed therapeutic myocardial infarction results in widening of the left ventricular outflow tract with consecutive gradient reduction. Follow-up studies show impressive clinical improvement, as well as further gradient reduction as a result of left ventricular remodeling. In this article, we provide an updated review of the latest results of percutaneous transluminal septal myocardial ablation.
Collapse
Affiliation(s)
- H Seggewiss
- Kardiologische Klinik, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
| | | | | |
Collapse
|
32
|
|
33
|
Faber L, Seggewiss H, Ziemssen P, Gleichmann U. Intraprocedural myocardial contrast echocardiography as a routine procedure in percutaneous transluminal septal myocardial ablation: detection of threatening myocardial necrosis distant from the septal target area. Catheter Cardiovasc Interv 1999; 47:462-6. [PMID: 10470478 DOI: 10.1002/(sici)1522-726x(199908)47:4<462::aid-ccd16>3.0.co;2-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative to surgery for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Visualization of the ablation area prior to induction of the chemical necrosis is possible by intraprocedural myocardial contrast echocardiography (MCE). We report on two patients in whom MCE showed opacification of the medial papillary muscle or the left ventricular posterolateral free wall. In both patients the correct ablation area could be identified by MCE after a change of the target vessel, thus avoiding potentially fatal complications due to induction of a necrosis of myocardium distant from the septal target area.
Collapse
Affiliation(s)
- L Faber
- Department of Cardiology, Heart Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | | | | | | |
Collapse
|
34
|
Abstract
BACKGROUND Percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced occlusion of septal branches with resulting reduction of LV outflow-tract gradient (LVOTG) is a new treatment option in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS In 1996 and 1997 we treated 114 symptomatic patients (56 female; age 53.3 +/- 15.6 years; 5 patients with prior myectomy and 5 with DDD pacer; most in NYHA class III. Five patients underwent re-PTSMA after failed first treatment. In the first 30 patients 1 to 3 septal branches were occluded by injection of 3.4 +/- 1.6 ml absolute alcohol via the central lumen after balloon occlusion of the proximal part of the septal branch. In the remaining patients myocardial contrast echocardiography was available, so that only one branch needed to be occluded. RESULTS LVOTG reduction was achieved in 107 (94%) patients: at rest from 73.8 +/- 36.5 to 18.6 +/- 19.7 mmHg (p < 0.00001). Maximal CK rise was 647 +/- 330 U/L. Two (1.8%) patients died during hospital stay. Due to permanent trifascicular block 11 (9.6%) patients required a permanent pacemaker. At 3 months follow-up in 87 patients we observed no cardiac complications, a further LVOTG reduction in 61 % patients, an ongoing symptomatic improvement (NYHA I or II; p < 0.0001 vs. pre PTSMA), and significant reduction of the left posterior wall thickness. CONCLUSIONS PTSMA of HOCM results in significant reduction of LVOTG. Careful monitoring during hospital stay is necessary because of the potential risks of the induced therapeutic infarction. Mid-term follow-up showed ongoing symptomatic improvement without cardiac complications. Remodeling after circumscribed septal infarction results in further LVOTG reduction in over 50% of the patients.
Collapse
Affiliation(s)
- H Seggewiss
- Department of Cardiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | | | | |
Collapse
|
35
|
Faber L, Seggewiss H, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation 1998; 98:2415-21. [PMID: 9832486 DOI: 10.1161/01.cir.98.22.2415] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative procedure for reducing the left ventricular outflow tract gradient (LVOTG) in hypertrophic obstructive cardiomyopathy. We report on the acute and mid-term results in 91 symptomatic patients with respect to intraprocedural myocardial contrast echocardiography (MCE). METHODS AND RESULTS PTSMA was intended for 46 women and 45 men (54.1+/-15.5 years). In 2 patients, the intervention could not be completed. In the first 30 patients the target vessel was determined by probatory balloon occlusion alone and in the remainder by additional intraprocedural MCE. Resting LVOTG was reduced from 73.8+/-35.4 to 16.6+/-18.1 and nostextrasystolic LVOTG from 149.3+/-42.5 to 61. 9+/-43.0 mm Hg (P<0.0001 each). In 10 (11%) patients, permanent DDD pacemaker implantation was necessary. Two (2%) patients died, 1 from ventricular fibrillation associated with treatment for chronic obstructive pulmonary disease after 9 days and 1 from fulminant pulmonary embolism after 2 days. After 3 months, mean New York Heart Association class was reduced from 2.8+/-0.6 to 1.1+/-1.0 (P<0.0001). The LVOTG remained reduced to 14.6+/-25.5 mm Hg at rest and 49. 1+/-48.7 mm Hg (P<0.0001 each). Four patients underwent successful repeat PTSMA. Determination of the target vessel by MCE was associated with a higher rate of acute (92% vs 70%; P<0.01) and mid-term (94% vs 64%; P<0.01) success. CONCLUSIONS PTSMA is a promising nonsurgical technique for reduction of symptoms and LVOTG in hypertrophic obstructive cardiomyopathy. MCE has been shown to be a useful addition to probatory balloon occlusion for target vessel selection. Prospective, long-term observations of larger populations and a comparison with the established forms of therapy are necessary to determine the definitive significance of PTSMA.
Collapse
Affiliation(s)
- L Faber
- Department of Cardiology, Heart Center NRW, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | | | | |
Collapse
|
36
|
Abstract
Clinical symptoms and diagnostic findings in patients with mitral stenosis are usually determined by the extent of the stenosis. Compared to a normal mitral valve area (MVA) of > 4 cm2, MVA in patients with severe mitral stenosis is usually reduced to < 1.5 cm2. In older patients symptoms are frequently influenced by concomitant diseases (e.g. atrial fibrillation, arterial hypertension or lung disease). An important diagnostic element besides anamnesis, auscultation, ECG and chest X-ray is echocardiography, which is required in order to measure non-invasively and reliably the mitral valve gradient (MVG), the MVA and morphologic changes to the valves, as well as concomitant valvular disease, ventricular functions and, where appropriate, left-atrial thrombi. In addition to the surgical treatment of patients with severe mitral stenosis, which has been an established procedure for 50 years, percutaneous balloon mitral valvuloplasty (MVP) has recently established itself as an alternative option. At the current time, the Inoue technique seems to display the most advantages. Following transseptal puncture, the Inoue balloon is guided transvenously into the left atrium and then into the left ventricle using a special support wire. The balloon is short and soft. Its special unfolding character enables it to be placed securely in the mitral valve without any risk of ventricular perforation (Figure 1). As with surgical commissurotomy, balloon valvuloplasty leads to a separation of fused commissures. This results in a significant reduction of MVG, accompanied by an increase in the MVA (Figure 2). The results and success of MVP are influenced by the morphology of the valves and the changes to the subvalvular apparatus. In randomized studies, the results of surgical commissurotomy were comparable with those of balloon mitral valvulotomy. In our hospital, an increase in MVA from 1.0 to 1.8 cm2 could be achieved in 899 patients (mean age 56 +/- 3 years). In younger patients with less significantly changed valves, the results were correspondingly more favorable than in older patients (Figure 3). Provided valve morphology is suitable, a relapse following previous surgical commissurotomy is not a contraindication for MVP. The MVP complication rate is very low in skilled hands: mortality is below 1%; mitral insufficiency occurs in 3 to 10% of interventions; we observed a severe mitral insufficiency in 5% of our patient group. Thromboembolic complications may be prevented after exclusion of atrial thrombi by transesophageal echocardiography. The occurrence of a hemodynamically significant atrial septum defect is a very rare event. The mid-term results (5 to 10 years) and the low restenosis rate following MVP in patients with suitable valves are comparable with those of surgical commissurotomy. In older patients with considerably changed, calcified and fibrotic valves, restenosis may be expected within 1 to 5 years. In these patients MVP represents no more than a palliative intervention in order to prolong the point of surgery, for example in patients where a concomitant aortic valve disease in itself is not yet an indication for surgery. Special indications are to be found in young patients with severe mitral stenosis yet few symptoms, in pregnant females and in emergency situations, as well as in patients with Grade II mitral stenosis with intermittent atrial fibrillation. Catheter therapy is much less invasive than surgery. In case of failure the patient still has the option of surgical therapy. Patients with morphologically significantly altered valves usually receive a valve replacement since an unsuccessful reconstruction would lead to a second operation within a very short time interval. Contraindications for MVP are thrombi in the left atrium, a previously existing > Grade II mitral regurgitation and marked, degenerative destruction of the subvalvular apparatus or extensive calcification of the valves. MVP thus represents a significant addi
Collapse
Affiliation(s)
- D Fassbender
- Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhruniversität Bochum, Bad Oeynhausen
| | | | | | | | | |
Collapse
|
37
|
Strick S, Ziemssen P, Seggewiss H, Fassbender D, Schmidt HK, Faber L. [Emergency percutaneous valvulotomy with the Inoue balloon in high grade mitral valve stenosis in pregnancy]. Med Klin (Munich) 1998; 93:541-5. [PMID: 9792020 DOI: 10.1007/bf03042663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CASE REPORT A 26-year-old pregnant woman (18th week of pregnancy) was admitted to a hospital with right heart failure and pulmonary congestion. After establishing the diagnosis of mitral stenosis, a first stabilization could be achieved by medical therapy with digitalis, diuretics, and beta-blockers. Readmission was necessary in the 23rd week. After failure of medical treatment the patient was transferred to our center. We decided to perform an emergency mitral valvulotomy with the Inoue balloon. Taking care of maximal radiation protection for mother and fetus doubling of the mitral valve opening are (from 0.6 cm2 to 1.3 cm2) could be achieved. The pleural effusions and tricuspid regurgitation disappeared. The patient was symptom-free and could be delivered from a male infant on schedule.
Collapse
Affiliation(s)
- S Strick
- Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Ocynhausen
| | | | | | | | | | | |
Collapse
|
38
|
Seggewiss H, Faber L, Meyners W, Bogunovic N, Odenthal HJ, Gleichmann U. Simultaneous percutaneous treatment in hypertrophic obstructive cardiomyopathy and coronary artery disease: a case report. Cathet Cardiovasc Diagn 1998; 44:65-9. [PMID: 9600527 DOI: 10.1002/(sici)1097-0304(199805)44:1<65::aid-ccd16>3.0.co;2-o] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary artery disease (CAD), whereas percutaneous transluminal septal myocardial ablation (PTSMA) is becoming increasingly significant in the therapy of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). We report the first ever simultaneous treatment, in a 62-yr-old patient, of significant HOCM and a 75% LAD stenosis from which the septal branch to be occluded stemmed. Using a double wire technique, first the septal branch was occluded through a fractional injection of 4 ml absolute alcohol, thus ablating the hypertrophied septal myocardium with reduction of the left ventricular outflow tract (LVOT) gradient at rest from 80 to 9 mmHg. Following this, the LAD stenosis was dilated and stented. Complications, in particular a trifascicular block or ventricular dysrhythmia, did not occur during the hospital stay. To conclude, combined PTSMA and PTCA may be considered as a therapeutic alternative to a combined surgical intervention in individual cases of symptomatic HOCM and CAD, provided that the potential complications are taken into account.
Collapse
Affiliation(s)
- H Seggewiss
- Kardiologische Klinik, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Hypertrophic cardiomyopathy is defined as a primary, sometimes familial and genetically fixed myocardial hypertrophy. In the obstructive form of the disease (HOCM) a dynamic outflow tract obstruction of the left, occasionally also the right ventricle can be found. HOCM is the most frequent cause of stress-induced syncope or sudden cardiac death in younger patients. An individual estimation of prognosis is difficult although several risk factors have been identified. In addition to standard therapy of symptomatic patients (medical treatment with betablockers and calcium-antagonists of verapamil-type as well as surgical myotomy/myectomy) DDD-pacemaker implantation and percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced septal branch occlusion have been introduced. After PTSMA significant outflow tract gradient reduction can be achieved in > 90% of patients. Due to remodeling after circumscribed myocardial necrosis further gradient reduction has been observed during follow-up. Optimization of ablated septal area by echocardiographic monitoring resulted in reduction of the most important complication (trifascicular block with need of permanent pacemaker implantation) and improvement of acute and follow-up results. Long-term follow-up and comparison with established treatment options are necessary to evaluate the definitive importance of the promising new treatment.
Collapse
Affiliation(s)
- U Gleichmann
- Kardiologische Klinik, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen
| | | |
Collapse
|
40
|
Faber L, Seggewiss H, Fassbender D, Bogunovic N, Strick S, Schmidt HK, Gleichmann U. [Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute results in 66 patients with reference to myocardial contrast echocardiography]. Z Kardiol 1998; 87:191-201. [PMID: 9586154 DOI: 10.1007/s003920050171] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In hypertrophic obstructive cardiomyopathy (HOCM) therapy, surgical myectomy and DDD pacemaker implantation are considered to be established extensions to medical treatment. As an alternative procedure for reducing the left ventricular outflow tract gradient (LVOTG), percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced septal branch occlusion has been introduced. We report on the acute results and the short-term clinical course following 66 PTSMA interventions in symptomatic patients (pts.) with HOCM. METHODS In pts. who were symptomatic despite adequate drug therapy (31 women, 35 men; mean age 52.9 +/- 15.0 years, range: 16-86) 66 PTSMA interventions were performed (4 pts. with a re-intervention). Septal branches were occluded by injection of 3.5 +/- 1.8 (1.5-11.0) ml ethanol (96%). In the first 30 pts. the target vessel was determined by probatory balloon occlusion (PBO) alone, in the following 36 by additional myocardial contrast echocardiography (MCE). In-hospital follow-up of LVOTG and clinical course were determined. RESULTS The invasively determined LVOTG could be reduced by > 50% or eliminated in 54 interventions (82%) with a mean reduction from 71.2 +/- 34.4 (4-174) to 18.0 +/- 21.5 (0-105) mmHg at rest and from 145.7 < or = 42.3 (68-257) to 63.7 +/- 49.3 (0-185) mmHg post extrasystole (p < 0.0001). All pts. experienced angina pectoris within the first 24 hours. The creatine kinase peak was 690 +/- 364 (201-1810) U/l after 11.0 +/- 5.4 (4-24) hours. 45 pts. (68%) developed trifascicular block, requiring temporary, or in 9 cases (14%) permanent, (DDD) pacemaker implantation. Two pts. (3%) died 9 and 2 days after successful intervention, due to uncontrollable ventricular fibrillation associated with betasympathomimetic and theophylline treatment for chronic obstructive pulmonary disease in one case, and fulminant pulmonary embolism in the other. The remaining pts. were discharged after 11.1 +/- 4.6 (5-24) days following an uncomplicated hospital course. The introduction of MCE was associated with a higher percentage of short-term success (92% vs. 70%, p < 0.015). CONCLUSIONS PTSMA in HOCM is a promising non-surgical technique for septal myocardial reduction with a consecutive reduction of the LVOTG. MCE has shown to be a useful addition to PBO for selection of the target vessel. Possible complications are trifascicular blocks requiring permanent pacemaker implantation and tachycardiac rhythm disturbances. Prospective, long-term observations of larger populations and a comparison with the established forms of therapy are necessary in order to determine the definitive significance of PTSMA.
Collapse
Affiliation(s)
- L Faber
- Kardiologische Klinik Herz-und Diabeteszentrum NRW Universitätsklinik der Ruhr-Universität Bochum
| | | | | | | | | | | | | |
Collapse
|
41
|
Seggewiss H. Acute Results of Catheter Treatment in Hypertrophic Obstructive Cardiomyopathy. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)84498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
Seggewiss H, Gleichmann U, Faber L, Fassbender D, Schmidt HK, Strick S. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute results and 3-month follow-up in 25 patients. J Am Coll Cardiol 1998; 31:252-8. [PMID: 9462563 DOI: 10.1016/s0735-1097(97)00508-1] [Citation(s) in RCA: 170] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We report the acute results and midterm clinical course after percutaneous transluminal septal myocardial ablation (PTSMA) in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). BACKGROUND In the treatment of HOCM, surgical myectomy and DDD pacemaker therapy are considered the standard procedural extensions to drug therapy with negatively inotropic drugs. As an alternative nonsurgical procedure for reducing the left ventricular outflow tract (LVOT) gradient, PTSMA by alcohol-induced septal branch occlusion was introduced. However, clinical follow-up has not been sufficiently described. METHODS In 25 patients (13 women, 12 men; mean [+/- SD] age 54.7 +/- 15.0 years) who were symptomatic despite sufficient drug therapy, 1.4 +/- 0.6 septal branches were occluded with an injection of 4.1 +/- 2.6 ml of alcohol (96%) to ablate the hypertrophied interventricular septum. After 3-months, follow-up results of LVOT gradients and clinical course were determined. RESULTS The invasively determined LVOT gradients could be reduced in 22 patients (88%), with a mean reduction from 61.8 +/- 29.8 mm Hg (range 4 to 152) to 19.4 +/- 20.8 mm Hg (range 0 to 74) at rest (p < 0.0001) and from 141.4 +/- 45.3 mm Hg (range 76 to 240) to 61.1 +/- 40.1 mm Hg (range 0 to 135) after extrasystole. All patients had angina pectoris for 24 h. The maximal creatine kinase increase was 780 +/- 436 U/liter (range 305 to 1,810) after 11.1 +/- 6.0 h (range 4 to 24). Thirteen patients (52%) developed a trifascicular block for 5 min to 8 days requiring temporary (n = 8 [32%]) or permanent (DDD) pacemaker implantation (n = 5 [20%]). An 86-year old woman died 8 days after successful intervention of uncontrollable ventricular fibrillation in conjunction with beta-sympathomimetics in chronically obstructive pulmonary disease. The remaining patients were discharged after 11.3 +/- 5.4 days (range 5 to 24), after an uncomplicated hospital course. Clinical and echocardiographic follow-up was achieved in all 24 surviving patients after 3 months. No cardiac complications occurred. Twenty-one patients (88%) showed clinical improvement, with a New York Heart Association functional class of 1.4 +/- 1.1. A further reduction in LVOT gradient was shown in 14 patients (58%). CONCLUSIONS PTSMA of HOCM is a promising nonsurgical technique for septal myocardial reduction, with a consecutive reduction in LVOT gradient. Possible complications are trifascicular blocks, requiring permanent pacemaker implantation, and tachycardiac rhythm disturbances. Clinical long-term observations of larger patient series and a comparison with conventional forms of therapy are necessary to determine the conclusive therapeutic significance.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Angina Pectoris/etiology
- Angioplasty, Balloon, Coronary
- Cardiac Complexes, Premature/physiopathology
- Cardiomyopathy, Hypertrophic/drug therapy
- Cardiomyopathy, Hypertrophic/enzymology
- Cardiomyopathy, Hypertrophic/therapy
- Catheter Ablation
- Cause of Death
- Coronary Vessels
- Creatine Kinase/analysis
- Depression, Chemical
- Echocardiography
- Ethanol/adverse effects
- Ethanol/therapeutic use
- Female
- Follow-Up Studies
- Heart Block/etiology
- Heart Block/therapy
- Heart Septum/pathology
- Humans
- Injections, Intra-Arterial
- Lung Diseases, Obstructive/complications
- Male
- Middle Aged
- Myocardial Contraction/drug effects
- Pacemaker, Artificial
- Stroke Volume/physiology
- Sympathomimetics/adverse effects
- Treatment Outcome
- Ventricular Fibrillation/etiology
- Ventricular Function, Left/physiology
Collapse
Affiliation(s)
- H Seggewiss
- Department of Cardiology, Heart and Diabetes Center Nordrhein-Westfalch, University Hospital of the Ruhr University of Bochum, Bad Oeynhausen, Germany.
| | | | | | | | | | | |
Collapse
|
43
|
Seggewiss H, Faber L, Gleichmann U, Strick S, Ziemssen P. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: clinical and non-invasive follow-up results. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)81433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
44
|
Faber L, Seggewiss H, Fassbender D, Strick S, Schmidt H. Identification of patients requiring DDD-pacemaker after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
45
|
Seggewiss H, Faber L, Gleichmann U, Fassbender D, Strick S. Acute results of catheter treatment in hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)81432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
46
|
Faber L, Seggewiss H, Fassbender D, Strick S, Bogunovic N, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: identification of the target vessel by myocardial contrast echocardiography. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)81515-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
|
48
|
Knight C, Kurbaan AS, Seggewiss H, Henein M, Gunning M, Harrington D, Fassbender D, Gleichmann U, Sigwart U. Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the first series of patients. Circulation 1997; 95:2075-81. [PMID: 9133518 DOI: 10.1161/01.cir.95.8.2075] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Some patients with hypertrophic obstructive cardiomyopathy may gain symptomatic relief from a reduction in the extent of obstruction to left ventricular outflow. We present the outcome of the first series of patients treated with an alternative method of gradient reduction using catheter techniques. METHODS AND RESULTS Eighteen patients were treated with selective intracoronary alcohol injection to induce localized septal infarction. Patients underwent echocardiographic measurement of left ventricular dimensions and Doppler echocardiographic evaluation of left ventricular outflow tract gradients before the procedure, on the first postoperative day, and at a median follow-up of 3 months after the procedure. In addition, patients underwent exercise testing and symptom evaluation before and 3 months after nonsurgical septal reduction. There was a significant reduction in left ventricular outflow tract obstruction after the procedure (preprocedure, 67 mm Hg [95% CI, 48 to 87 mm Hg]; postprocedure, 25 mm Hg [95% CI, 16 to 34 mm Hg]; P=.0006), which persisted at 3-month follow-up (22 mm Hg [95% CI, 12 to 32 mm Hg]; P=.001). This was associated with a significant improvement in symptoms. There was a small but not significant increase in exercise capacity (n=10; preprocedure, 418 seconds [95% CI, 273 to 563 seconds]; postprocedure, 452 seconds [95% CI, 283 to 621 seconds). Left ventricular dimensions were not significantly altered by nonsurgical septal reduction. CONCLUSIONS Nonsurgical septal reduction significantly reduces left ventricular outflow tract obstruction and improves symptoms in some patients with hypertrophic obstructive cardiomyopathy. The technique may provide an alternative to surgical myomectomy in selected patients.
Collapse
Affiliation(s)
- C Knight
- Royal Brompton Hospital, London, England
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- U Gleichmann
- Kardiologische Klinik, Herz- und Diabeteszentrum, Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | | |
Collapse
|
50
|
Seggewiss H, Gleichmann U. [Balloon dilatation or bypass surgery in coronary multi-vessel disease? Change of therapy following conclusion of randomized studies?]. Dtsch Med Wochenschr 1996; 121:1204-6. [PMID: 8925747 DOI: 10.1055/s-2008-1043128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- H Seggewiss
- Kardiologische Klinik, Herz-und Diabeteszentrum Nordrhein-Westfalen, Universität Bochum, Bad Oeynhausen
| | | |
Collapse
|