Hypertrophic cardiomyopathy

摘要

In the Seminar on hypertrophic cardiomyopathy (Jan 19, p 242), Barry Maron and Martin Maron thoroughly show that hypertrophic cardiomyopathy is a complex disease, frequently associated with therapeutic uncertainties. However, we would have liked a more balanced view of the available data on interventional treatment of hypertrophic obstructive cardiomyopathy. Maron and Maron overstate procedural mortality for alcohol septal ablation (ASA) on the basis of studies that included mainly high-risk patients, unsuitable for myectomy, treated during the learning curve of the performing physicians, and using extremely high alcohol quantities compared with latest practice. The correlation between ASA and increased incidence of sudden death noted by Maron and Maron is based on studies that in fact showed no difference in sudden death outcome between ASA and myectomy, or no increase in appropriate implantable cardioverter defibrillator discharges or mortality attributable to sudden cardiac death after ASA. Maron and Maron present data on zero mortality after septal myectomy although some mortality has been reported in the same subcohort of patients. The first long-term follow-up studies after ASA and an updated meta-analysis have shown similar long-term mortality and functional status after both treatments. In our view, ASA is an established treatment that benefits a large proportion of patients with hypertrophic obstructive cardiomyopathy. Both treatments have merits and drawbacks, and we should acknowledge that these are complementary treatments rather than adversaries.