title: [Efficacy comparison between conservative therapy and septal ablation in patients with hypertrophic obstructive cardiomyopathy].
abstract: Objective:To compare the effects of septal ablation (SA) versus conservative medication (CM) on the hemodynamic, clinical status and survival in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods:This retrospective study included 350 consecutive patients with HOCM (mean age (51.3±13.5) years old) hospitalized in Anzhen Hospital between September 2002 to September 2014. The patients were followed up to 14 years and the follow up rate was 99.4% (348/350). Overall and cardiac-related mortalities were compared between SA group (n=184) and CM group (n=184). Moreover, SA related cardiac function and hemodynamics improvement were also evaluated, predictors for clinical events were evaluated by Cox regression analysis and Kaplan-Meier survival analysis was used to compare the total mortality between the two groups. The log-rank test was used to compare the survival curve differences between the two groups.Results:The median follow-up period was 4 years (1-14 years). The annual mortalities of SA and CM were 2.4% and 0.6% respectively (P<0.001) and cumulative sudden cardiac death (SCD)rates were 3.61% (6/166) and 0.54% (1/184) respectively (P=0.031). Multivariate regression analysis demonstrated that the age was the most important independent predictor for overall mortality(HR=1.259, 95%CI1.101-1.438,P=0.001). In addition, left ventricular outflow tract (LVOT) gradient was significantly reduced post SA (peak velocity of LVOT: baseline (4.23±1.05) m/s, post SA: (1.83±0.79) m/s,P<0. 01) and heart function was also significantly improved post SA (NYHA at baseline: 2.97±0.29, post SA: 1.74±0.53,P<0.001).Conclusion:SA could significantly improve the hemodynamics and clinical status in drug-resistant patients with HOCM. In comparison to patients received CM, overall survival rate was significantly higher in SA group without extra risk of SCD.
authors.affiliation: *Department of Cardiology, Anzhen Hospital Affiliated to Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China.
authors.forename: H
authors.initials: H
authors.lastname: Zhao
authors.forename: J Q
authors.initials: JQ
authors.lastname: He
authors.forename: B
authors.initials: B
authors.lastname: Jiang
authors.forename: Y C
authors.initials: YC
authors.lastname: Gao
authors.forename: Q
authors.initials: Q
authors.lastname: Li
authors.forename: C Y
authors.initials: CY
authors.lastname: Wu
authors.forename: T Y
authors.initials: TY
authors.lastname: Jiang
mesh_terms: D002312:Cardiomyopathy, Hypertrophic; D017115:Catheter Ablation; D000072700:Conservative Treatment; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome