• CARDIAC PROCEDURES AND THERAPY

The focus of this issue of Heart is hypertrophic cardiomyopathy (HCM). As our ability to diagnosis HCM has improved due to the wide availability of genetic testing and advances in imaging, there has been increasing interest in the clinical presentation, outcomes and management of these patients.

Dynamic left ventricular (LV) outflow obstruction is a key feature of hypertrophic cardiomyopathy (HCM) yet the impact of relief of obstruction with alcohol septal ablation (ASA) on clinical outcomes remains unclear. In a series of 270 patients with HCM undergoing ASA, the outflow gradient was reduced to less than 30 mm Hg in 77% of patients while 23% has persistent subaortic obstruction after the procedure (see page 1793). Persistent obstruction was associated with a higher cardiovascular mortality rate at 1, 5 and 10 years of follow-up (figure 1). Multivariate predictors of cardiovascular mortality were persistent outflow obstruction early after hospital discharge (HR 2.95, 95% CI 1.26 to 6.91; p=0.01) and baseline septum thickness (HR 1.07, 95% CI 1.01 to 1.13; p=0.02).

These findings are put into perspective in the editorial by Steggerd and ten Berg (see page 1775) which summarizes the previously published data on results with surgical meyctomy compared to ASA for HCM with subaortic obstruction. They note that most common adverse clinical outcome in the study by Veselka et al (see page 1793) was resuscitated sudden cardiac death. However, despite a …