title: Predictors of an optimal clinical outcome with alcohol septal ablation for obstructive hypertrophic cardiomyopathy.
abstract: BACKGROUND
  Alcohol septal ablation has emerged as a therapy for patients with obstructive hypertrophic cardiomyopathy (HCM). However, there are limited data on the predictors of success with the procedure.
  
  
  METHODS
  We examined patient characteristics and cardiac morphology as well as procedural data on 166 HCM patients (mean age, 63 years; 43% men), who underwent ablation at Mayo Clinic. Patients were contacted to determine vital status and symptoms to assess the primary endpoint of survival free of death and severe symptoms (New York Heart Association, class III or IV dyspnea).
  
  
  RESULTS
  The strongest patient characteristics that predicted clinical success were older age, less severe left ventricular outflow tract gradient, lesser ventricular septal hypertrophy, and a smaller left anterior descending (LAD) diameter. Mitral valve geometry or ventricular septal morphology did not predict outcome. Patients with ≥3 characteristics (age ≥65 years, gradient <100 mmHg, septal hypertrophy ≤18 mm, LAD diameter <4.0 mm) had superior 4-year survival free of death and severe symptoms (90.4%) in comparison to those with two characteristics (81.6%) and ≤1 characteristic (57.5%). Case volume with >50 patients was an independent predictor of survival free of severe symptoms. The volume of alcohol injected, number of arteries injected, or size of septal perforator artery were not predictive of clinical success.
  
  
  CONCLUSIONS
  Greater case volume and selection for key patient and anatomic characteristics are associated with superior outcomes with alcohol septal ablation.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. paul.sorajja@mayo.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Sorajja
authors.forename: Josepha
authors.initials: J
authors.lastname: Binder
authors.forename: Rick A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: John F
authors.initials: JF
authors.lastname: Bresnahan
authors.forename: Steve R
authors.initials: SR
authors.lastname: Ommen
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000792:Angiography / Q000379:methods; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000431:Ethanol