Impact of ethanol dosing on the long-term outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy -: A single-center, prospective, and randomized study
Impact of ethanol dosing on the long-term outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy -: A single-center, prospective, and randomized study
复制标题
DOI：
10.1253/circj.70.1550
复制
发表时间：
2006-12-01
影响因子：
3.3
通讯作者：
Cervinka, Pavel
中科院分区：
文献类型：
--
作者：
Veselka, Josef;Duchohova, Radka;Cervinka, Pavel
研究了乙醇剂量对阻塞性肥厚性心肌病酒精性室间隔消融术（ASA）长期预后的影响。方法与结果54例接受ASA治疗的患者（年龄24 ~ 82岁，65%为女性），根据乙醇注射剂量随机分为2组：A组1 ~ 2 ml， B组1 ~ 2 ml。在基线和随访期间获得临床和超声心动图资料。乙醇注射量分别为1.50 +/- 0.4和2.60 +/- 0.6 ml (p < 0.001)，肌酸激酶mb峰值分别为2.25 +/- 1.00和2.62 +/- 1.57 μ kat/L （p=0.02）。ASA后的中位随访时间为39个月（范围6-72个月），在此期间，两组患者均有1例死亡，需要进行1次重复手术。两组在流出压力梯度、呼吸困难（纽约心脏协会功能分级）和心绞痛（加拿大心血管协会分级）方面均有显著且相似的改善（p < 0.001）。B组左室射血分数（LVEF）显著降低（81 +/- 7 vs 75.7%; p=0.002），但a组无显著降低（80 +/- 7 vs 79 +/- 7%; p=0.67）。基底隔变薄B组比A组更明显（9.3 +/- 5.7 vs 6.6 +/- 3.4 mm; p=0.04）。结论在长期随访中，低剂量乙醇注入目标间隔分支可减少坏死灶的大小和基底间隔随后变薄，并保留LVEF。此外，低剂量（1-2毫升）与高剂量一样安全且血流动力学有效。
Background The impact of ethanol dose on the long-term outcome of alcohol septal ablation (ASA) for obstructive hypertrophic cardiornyopathy was investigated.Methods and Results Fifty-four patients (age 24-82 years; 65% women) undergoing ASA were randomized into 2 groups according to the dose of injected ethanol: Group A 1-2 ml, Group B > 2 ml. Clinical and echocardiographic data were obtained at baseline and during follow-up. The volume of ethanol injected was 1.50 +/- 0.4 and 2.60 +/- 0.6 ml (p < 0.001) with a subsequent peak of creatine kinase-MB of 2.25 +/- 1.00 and 2.62 +/- 1.57,mu kat/L, (p=0.02) in Groups A and B, respectively. The median follow-up was 39 (range 6-72) months after ASA, during which 1 patient died and 1 repeat procedure was necessary in both groups of patients. Both groups had a significant and similar improvement in outflow pressure gradient, dyspnea (New York Heart Association functional class) and angina pectoris (Canadian Cardiovascular Society class) (p < 0.001). There was a significant decrease in the left ventricular ejection fraction (LVEF) in Group B (81 +/- 7 vs 75 7%; p=0.002), but not in Group A (80 +/- 7 vs 79 +/- 7%; p=0.67). Thinning of the basal septum was more pronounced in Group B than in Group A (9.3 +/- 5.7 vs 6.6 +/- 3.4 mm; p=0.04).Conclusions A lower dose of ethanol injected into the target septal branch reduces both the size of necrosis and subsequent thinning of the basal septum, and preserves LVEF during long-term follow-up. Moreover, the low dose (1-2 ml) is as safe and as hemodynamically efficacious as higher doses.