title: Effect of alcohol dosage on long-term outcomes after alcohol septal ablation in patients with hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  The aim of this study is to assess the long-term effects of alcohol dosage in alcohol septal ablation (ASA) on mortality and adverse arrhythmic events (AAE).
  
  
  BACKGROUND
  ASA can be performed to reduce left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy (HCM). However, the effect of alcohol dosage on long-term outcomes is unknown.
  
  
  METHODS
  This retrospective cohort study includes 296 HCM patients (age 60 ± 22 years, 58% male) who underwent ASA because of symptomatic LVOT obstruction. Twenty-nine patients (9.8%) were excluded because the alcohol dosage could not be retrieved. Primary endpoints were all-cause mortality and AAE.
  
  
  RESULTS
  During 6.3 ± 3.7 years of follow-up, all-cause mortality and AAE rates were similar in patients who received ≤2.0 mL (n = 142) and >2.0 mL (n = 121) alcohol during ASA. Age was the only independent predictor of mortality (HR 1.1 95% CI 1.0-1.1, P < 0.001). Predictors of AAE were maximum CK-MB >240 U/L (HR 3.3 95% CI 1.5-7.2, P = 0.003), and sudden cardiac death survivor (HR 5.9 95% CI 1.7-20.3, P = 0.004). There was a mild to moderate correlation between CK-MB levels and amount of alcohol (Spearman's ρ 0.39, P < 0.001), cross-sectional area of the target septal branch ostium/ostia (Spearman's ρ 0.19, P = 0.003), and maximum ventricular wall thickness (Spearman's ρ 0.17, P = 0.006).
  
  
  CONCLUSIONS
  Alcohol dosage appears not to have a long-term effect on mortality and AAE. A larger infarct size created by ASA increases the risk of AAE, and extended monitoring of these patients is advised. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors.forename: Max
authors.initials: M
authors.lastname: Liebregts
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Vriesendorp
authors.affiliation: Department of Cardiology, Martini Hospital, Groningen, The Netherlands.
authors.forename: Robbert C
authors.initials: RC
authors.lastname: Steggerda
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors.forename: Jippe C
authors.initials: JC
authors.lastname: Balt
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: Ten Cate
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
authors.forename: Michelle
authors.initials: M
authors.lastname: Michels
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004452:Echocardiography; D000431:Ethanol / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006346:Heart Septum; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
chemical_list: D000431:Ethanol
keywords: alcohol septal ablation; hypertrophic cardiomyopathy; structural heart disease intervention