| Objective: To retrospectively analyze and compare the clinical prognosis of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy of different course.Methods: This study was a retrospective control study.A total of 211 patients with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation in Heart Center of the people’s Hospital of Liaoning Province from January 1,2008 to December 31,2018 were collected.According to the time from the first onset to percutaneous transluminal septal myocardial ablation(Time to Ablation,TTA),the patients were divided into three groups: TTA<3 years group,3≤TTA≤5 years group,TTA>5 years group.The clinical data and the results of chemical ablation were collected and analyzed by SPSS 22.0 statistical software.The thickness of interventricular septum,the pressure gradient of left ventricular outflow tract,the grade of NYHA cardiac function,the incidence of complications after PTSMA,the incidence of re-PTSMA or resection of interventricular septum,cardiogenic mortality and all-cause mortality were analyzed and compared among different groups.Results: A total of 211 patients were included,including 112 cases in TTA<3 years group(53.08%),42 cases in 3≤TTA≤5 years group(19.91%)and 57 cases in TTA>5years group(27.01%).TTA<3 years group vs 3≤TTA≤5 years group vs TTA>5 years group in the age of onset(49.94±12.46 vs 44.07±13.77 vs 40.00±16.38,p=0.00),operation age(50.19±12.51 vs 48.14±13.75 vs 54.18±11.63,p=0.04)and history of atrial fibrillation(10.71% vs 9.52% vs 24.56%,p=0.03),there were statistical differences(p>0.05).There was no significant difference in the amount of alcohol(2.06±0.96 vs 2.09±0.98 vs 2.15±1.09,p=0.86)and the number of ablation vessels(1.15±0.36 vs 1.17±0.38 vs 1.21±0.50,p=0.67)among the three groups of patients treated with PTSMA.During the perioperative period of PTSMA,the incidence of high atrioventricular block in TTA>5 years group was higher than that in the other two groups.In TTA>5 years group vs TTA<3 years group vs 3≤TTA≤5 years group third degree atrioventricular block incidence(5.4% vs 4.8% vs 8.77%,p=0.63),but there was no statistical difference(p>0.05).There was no significant difference among the three groups in perioperative PTSMA related to interventricular septal perforation,pericardial tamponade,paroxysmal ventricular tachycardia,ventricular fibrillation and left and right bundle branch block(p>0.05).However,in the TTA<3 years group,a82-year-old female patient developed pericardial tamponade before absolute alcohol was injected during the operation and died without PTSMA treatment.There were significant differences in the thickness of interventricular septum(22.11±2.98 vs22.67±3.93 vs 23.53±3.66,p=0.04)and LVOTG[23(18,27)vs 26(20,32)vs 24(21,29),p=0.02] and the percentage of decrease of LVOTG[58(47,75)vs 52(39,60)vs 49(42,62),p=0.01] in TTA<3 years group vs 3≤TTA≤5 years group vs TTA>5 years group.There was no significant difference in left atrial diameter(42.75±6.54 vs 43.52±4.50 vs44.23±5.14,p=0.29)and ejection fraction[60(59,65)vs 60(57,62)vs 60(58,65),p=0.37] among the three groups.During the follow-up period,the clinical symptoms(chest pain,amausia or syncope)and the grade of cardiac function in the three groups were improved compared with those before operation,and there was significant difference(p<0.05).During the follow-up period,the incidence of re-PTSMA or interventricular septal resection(0 vs 2.38% vs5.26%,p=0.03)and permanent pacemaker implantation(1.79% vs 2.38% vs 10.5%,p=0.03)in TTA>5 years group was higher than that in TTA<3 years group and 3≤TTA≤5 years group.There was significant difference among the three groups(p<0.05).The incidence of new postoperative atrial fibrillation(2.68% vs 4.76% vs 8.77%,p=0.19)was the highest in the group with TTA>5 years group,and there was no statistical difference.There were 2 cases of stroke in TTA>5 years group,including 1 case of cerebral embolism and 1 case of cerebral hemorrhage.A total of 5 patients died during follow-up,including 2 cases in TTA<3 years group,1 case in 3≤TTA≤5 years group,and 2 cases in TTA>5 years group,there is no statistical difference(p=0.41).During the follow-upperiod,the total incidence of MACE events in TTA>5 years group was significantly higher than that in TTA<3 years group and 3≤TTA≤5 years group(5.36% vs 11.9%vs 31.58%,p=0.00).In pairwise comparison,there were significant differences between TTA>5 years group and TTA<3 years group and 3≤TTA≤5 years group(p<0.05),but there was no significant difference in the total incidence of MACE events between TTA<3 years group and 3≤TTA≤5 years group(p>0.05).Conclusions: The preoperative course of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy has an important influence on the clinical prognosis after percutaneous transluminal septal myocardial ablation.Early PTSMA can improve the clinical prognosis.Even if the operation is successful,the incidence of adverse events in patients with delayed PTSMA,especially those with TTA>5 years group,is still high during the follow-up period.Patients with hypertrophic obstructive cardiomyopathy should be treated with PTSMA,in time to relieve the high pressure load of left ventricular outflow tract in order to improve the clinical prognosis. |
PDF Full Text Request