Heart failure & cardiomyopathiesCohort study
Long-Term Outcomes After Septal Reduction Therapies in Obstructive Hypertrophic Cardiomyopathy: Insights From the SHARE Registry
- Retrospective cohort study
- multicentre
- international registry
Authors' conclusion
Successful short- and long-term relief of outflow tract obstruction was observed in experienced multidisciplinary HCM centers. A subset of patients progressed to develop HF, but event-free survival at 10 years was 83% and ventricular arrhythmias were rare. Older age, female sex, and SRT during childhood were associated with a greater risk of developing HF.
Study context
- Population
- Patients with obstructive hypertrophic cardiomyopathy (HCM) undergoing septal reduction therapy (SRT) at 13 high-volume HCM centres (SHARE registry)of 10,225 in SHARE
- Participants
- 1,832 patients
- Exposure
- Alcohol septal ablation vs Septal myectomy
- Alcohol septal ablationn = 455
- Septal myectomyn = 1,377
- Outcome
- HF composite (cardiac transplantation, LV assist device, LVEF <35%, NYHA class III or IV), ventricular arrhythmia composite (SCD, resuscitated cardiac arrest, appropriate ICD therapy) or HCM-related death
Main finding
As reported in the abstract
HCM-related death
77 (4%); 0.6% per year
Heart failure (HF) composite
236 (13%); 1.9% per year
Ventricular arrhythmia composite
87 (5%); 0.7% per year
Observational data: associations, not effects.
Further findings
Predictors of HCM death and HF composite (adults, multivariable)
| Comparison | HR (95 CI) | P value | |
|---|---|---|---|
| Older age at SRT · HCM death | 1.22 (1.1–1.3) | P < 0.01 | |
| Female · HF composite | 1.4 (1.1–1.8) | P < 0.01 | |
| 0.512Hazard ratio (log scale) |
| Outcome | HR (95 CI) | P value | |
|---|---|---|---|
| Predictors of HCM death and HF composite (adults, multivariable) — Older age at SRT · HF composite, per 5-year increase | 1.14 (1.1–1.2) | P < 0.01 | |
| 0.512Hazard ratio (log scale) |
Maximal LV outflow tract gradient <50 mm Hg · 1 year
- Gradient <50 mm Hg
- 1499 of 1565 (92%)
HF composite in pediatric patients · median 13 years
- HF composite
- 26 of 343 (16%)
- Free of recurrent LV outflow tract obstruction
- 96%
Periprocedural 30-day mortality
- 30-day mortality
- 0.4% (8 of 1832)
Safety
De novo AF after SRT
- De novo AF
- 387 patients (21%)
Original publication
Summarised from the published abstract; every number is checked against it