title: Influence of Septal Thickness on the Clinical Outcome After Alcohol Septal Alation in Hypertrophic Cardiomyopathy.
abstract: We assessed the influence of interventricular septal thickness (IVSd) on the clinical outcome and survival after alcohol septal ablation (ASA) in patient with hypertrophic cardiomyopathy.
  
  
  
  We analyzed 531 patients with hypertrophic cardiomyopathy (age: 56±14 years, men 55%) treated with ASA. Survival status was obtained 7.9±4.0 years after ASA. Baseline IVSd was inversely associated with survival (hazard ratio [HR] for 1 mm increment, 1.13; confidence interval, 1.05-1.21; P<0.001) after adjustment for age, sex, body mass index, and ASA-performing center. Compared with patients with baseline IVSd <20 mm, patients with baseline IVSd ≥25 mm had reduced survival (HR, 5.0; CI, 2.1-12), whereas patients with baseline IVSd 20 to 24 mm had similar survival (HR, 1.4; CI, 0.7-2.8). Baseline IVSd was not correlated with New York Heart Association class, Canadian Cardiology Society class, or syncope. Clinical outcome was assessed 0.6±0.6 years after ASA. IVSd was not related to left ventricular outflow tract gradient reduction at rest (P=0.883) or during Valsalva maneuver (P=0.885). The proportion of patients in New York Heart Association class 3 to 4 was reduced from 86% to 10%; in Canadian Cardiology Society class 3 to 4 from 26% to 2%; and with syncope from 25% to 2%. There were no correlations between baseline IVSd and New York Heart Association class (P=0.067), Canadian Cardiology Society class (P=0.106), or syncope (P=0.426) after ASA.
  
  
  
  ASA had equal effects on left ventricular outflow tract gradients and symptoms throughout the spectrum of septal hypertrophy. Severe septal hypertrophy before ASA remained a marker of reduced survival after ASA with a 5-fold increased risk of all-cause mortality in patients with baseline IVSd >25 mm compared with patients with baseline IVSd <20 mm.
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.). mortenjensen@dadlnet.dk.
authors.forename: Morten K
authors.initials: MK
authors.lastname: Jensen
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
authors.forename: Linda
authors.initials: L
authors.lastname: Jacobsson
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
authors.forename: Vibeke
authors.initials: V
authors.lastname: Almaas
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
authors.forename: Frank
authors.initials: F
authors.lastname: van Buuren
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
authors.forename: Peter R
authors.initials: PR
authors.lastname: Hansen
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hansen
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Eriksson
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
authors.forename: Henning
authors.initials: H
authors.lastname: Bundgaard
authors.affiliation: From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
authors.forename: Lothar
authors.initials: L
authors.lastname: Faber
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000328:Adult; D000368:Aged; D064752:Atrial Remodeling; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005060:Europe; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling
chemical_list: D000431:Ethanol
keywords: cardiomyopathy; chest pain; dyspnea; hypertrophy; syncope