Septal reduction therapy in elderly patients with obstructive hypertrophic cardiomyopathy was associated with a lower rate of death and defibrillator discharge (32%) compared to no SRT (55%).
Cohort (n=1,110)
No
Absolute Event Rate: 32% vs 55%
Background We report characteristics and outcomes of elderly patients with hypertrophic cardiomyopathy (HCM) with basal septal hypertrophy and dynamic left ventricular outflow tract obstruction. Methods and Results We studied 1110 consecutive elderly patients with HCM (excluding moderate or greater aortic stenosis or subaortic membrane, age 80±5 years range, 75–92 years, 66% women), evaluated at our center between June 2002 and December 2018. Clinical and echocardiographic data, including maximal left ventricular outflow tract gradient, were recorded. The primary outcome was death and appropriate internal defibrillator discharge. Hypertension was observed in 72%, with a Society of Thoracic Surgeons (STS) score (8.6±6); while 80% had no HCM‐related sudden cardiac death risk factors. Left ventricular mass index, basal septal thickness, and maximal left ventricular outflow tract gradient were 127±43 g/m 2 , 1.7±0.4 cm, and 49±31 mm Hg, respectively. A total of 597 (54%) had a left ventricular outflow tract gradient >30 mm Hg, of which 195 (33%) underwent septal reduction therapy (SRT; 79% myectomy and 21% alcohol ablation). At 5.1±4 years, 556 (50%) had composite events (273 53% in nonobstructive, 220 55% in obstructive without SRT, and 63 32% in obstructive subgroup with SRT). One‐ and 5‐year survival, respectively were 93% and 63% in nonobstructive, 90% and 63% in obstructive subgroup without SRT, and 94% and 84% in the obstructive subgroup with SRT. Following SRT, there were 5 (2.5%) in‐hospital deaths (versus an expected Society of Thoracic Surgeons mortality of 9.2%). Conclusions Elderly patients with HCM have a high prevalence of traditional cardiovascular rather than HCM risk factors. Longer‐term outcomes of the obstructive SRT subgroup were similar to a normal age‐sex matched US population.
Alashi et al. (Thu,) conducted a cohort in Hypertrophic cardiomyopathy (n=1,110). Septal reduction therapy (SRT) vs. Obstructive HCM without SRT and nonobstructive HCM was evaluated on Death and appropriate internal defibrillator discharge. Septal reduction therapy in elderly patients with obstructive hypertrophic cardiomyopathy was associated with a lower rate of death and defibrillator discharge (32%) compared to no SRT (55%).