Alcohol Septal Ablation in Patients with Hypertrophic Cardiomyopathy and Obesity
Abstract
The article represents a literature review and analysis of actual experience of the treatment of patients with hypertrophic cardiomyopathy (HCM) and obesity. Obesity is a significant risk factor for the development and course of cardiovascular diseases. There are a lot of articles describing the “obesity paradox” as more favorable prognosis in patients with overweight and obesity compared to those with normal BMI. It refers to a lower level of hospital mortality and mortality in long-term follow-up after percutaneous interventions and open heart surgery. However, these findings are not reliable, since they do not take into account the presence of comorbid and concomitant conditions in patients, have specific criteria for patient selection for the study and use only BMI for the classification of overweight. This reflects the reciprocal causality: weight loss is the result of a serious illness, not its cause.
It has been shown that obesity in patients with HCM is associated with a higher left ventricle myocardial mass, more severe symptoms, lower exercise tolerance, and labile obstructive hemodynamics. We studied the effect of obesity on the results of alcohol septal ablation (ASA) in patients with HCM.
Obesity is an important risk factor for the development of cardiovascular diseases and is also able to affect cardiac surgery risks. It has been shown that ASA in patients with HCM and obesity in most cases may improve clinical course of the disease (symptoms and functional class improvement). Also, there is no difference in the anatomical and hemodynamic results, mortality rate in obese patients and those with normal BMI in the immediate follow-up. ASA is recommended as a first-line method in patients with HCM and obesity.
References
- Canepa M, Sorensen L, Pozios I, Dimaano V, Luo H, Pinheiro A, et al. Comparison of Clinical Presentation, Left Ventricular Morphology, Hemodynamics, and Exercise Tolerance in Obese Versus Nonobese Patients With Hypertrophic Cardiomyopathy. Am J Cardiol. 2013 Oct 15;112(8):1182–9 https://doi.org/10.1016/j.amjcard.2013.05.070
- Gersh B, Maron B, Bonow R, Dearani J, Fifer M, Link M, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy. J Am Coll Cardiol. 2011 Dec 13;58(25):e212–60. https://doi.org/10.1016/j.jacc.2011.06.011
- Uwaifo G, Fallon E, Calis K, Drinkard B, McDuffie J, Yanovski J. Improvement in Hypertrophic Cardiomyopathy after Significant Weight Loss: Case Report. South Med J. 2003 Jun;96(6):626–31. https://doi.org/10.1097/01.SMJ.0000053254.23595.14
- Ellis S, Elliott J, Horrigan M, Raymond R, Howell G. Low-Normal or Excessive Body Mass Index: Newly Identified and Powerful Risk Factors for Death and Other Complications With Percutaneous Coronary Intervention. Am J Cardiol. 1996 Sep 15;78(6):642–6. https://doi.org/10.1016/S0002-9149(96)00386-4
- Holroyd E, Sirker A, Kwok C, Kontopantelis E, Ludman P, De Belder, et al. The Relationship of Body Mass Index to Percutaneous Coronary Intervention Outcomes: Does the Obesity Paradox Exist in Contemporary Percutaneous Coronary Intervention Cohorts? Insights From the British Cardiovascular Intervention Society Registry. JACC Cardiovasc Interv. 2017 Jul 10;10(13):1283–92. https://doi.org/10.1016/j.jcin.2017.03.013
- Niedziela J, Hudzik B, Niedziela N, Ga(sior M, Gierlotka M, Wasilewski J, et al. The obesity paradox in acute coronary syndrome: a meta-analysis. Eur J Epidemiol. 2014 Nov;29(11):801–12. https://doi.org/10.1007/s10654-014-9961-9
- Stamou S, Nussbaum M, Stiegel R, Reames M, Skipper E, Robicsek F., et al. Effect of Body Mass Index on Outcomes After Cardiac Surgery: Is There an Obesity Paradox?. Ann Thorac Surg. 2011 Jan;91(1):42–7. https://doi.org/10.1016/j.athoracsur.2010.08.047
- Xia J, Lloyd-Jones D, Khan S. Association of body mass index with mortality in cardiovascular disease: New insights into the obesity paradox from multiple perspectives. Trends Cardiovasc Med. 2019 May;29(4):220–5. https://doi. org/10.1016/j.tcm.2018.08.006 дури АСА Р value 1-а група після процедури АСА 2-а група після процедури АСА Р value 0,592 42,66 ± 24,94 43 ± 25,39 0,943 0,991 1,36 ± 0,42 1,39 ± 0,48 0,765 0,497 1,92 ± 0,33 2,03 ± 0,63 0,244 0,043 1,45 ± 0,35 1,08 ± 0,21 0,000 0,526 48,04 ± 7,31 49,78 ± 9,41 0,268 0,095 18,59 ± 3,61 18,16 ± 4,17 0,553 0,179 24,35 ± 11,86 23,42 ± 13,55 0,696 0,610 61,30 ± 4,61 63,20 ± 4,43 0,026 0,002 4,84 ± 0,42 4,57 ± 0,63 0,001 истолічний індекс; УІ – ударний індекс.
- Mensah G, Brown D. An Overview Of Cardiovascular Disease Burden In The United States. Health Aff (Millwood). 2007 Jan–Feb;26(1):38–48. https://doi.org/10.1377/hlthaff.26.1.38
- Iliodromiti S, Celis-Morales C, Lyall D, Anderson J, Gray S, Mackay D, et al. The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent. European Heart Journal. 2018 May;39(17):1514–20. https://doi.org/10.1093/eurheartj/ehy057
