ABC | Volume 112, Nº4, April 2019

Original Article Yang Li Risk factors for PTSMA complications Arq Bras Cardiol. 2019; 112(4):432-438 Table 3 – Multivariate logistic regression for potential risk factors for PTSMA complications p value Odds ratio CI Age (years) 0.767 0.995 0.959-1.031 Male 0.198 0.527 0.198-1.399 CAD 0.761 0.761 0.132-4.407 Hypertension 0.003 4.856 1.732-13.609 DM 0.176 6.620 0.428-12.527 Alcohol volume 0.385 0.757 0.403-1.420 Number of ablation septal 0.436 0.682 0.370-2.253 CAD: coronary artery disease; DM: diabetes mellitus. Table 4 – Comparisons of clinical and echocardiographic characteristics between patients with and without hypertension Hypertension (n = 46) No hypertension (n = 178) p value Age 58.13 ± 10.10 ** 45.23 ± 13.95 0.000 Female 28 ** 75 0.025 DM 3 ** 0 0.007 CAD 5 8 0.000 History of heart failure 7 * 8 0.010 LVOTD (mm) 9.56 ± 2.76 9.24 ± 2.62 0.480 HR (beats/min) 70.57 ± 11.13 71.37 ± 12.46 0.692 EF 0.63 ± 0.07 0.65 ± 0.07 0.113 CAD: coronary artery disease; DM: diabetes mellitus; HR: heart rate; LVOTD: left ventricular outflow tract diameter; EF: ejection fraction. Table 5 – In hospital complications and late interventional failure according to experience Early experience (n = 75) Intermediate experience (n = 93) Late experience (n = 56) p value Events 31 22 13 0.022 No events 44 71 43 Patients’ demographic characteristics should be the potential risks for PTSMAprocedure complications.However, according toa previous report, 18 none of the studied baseline echocardiographic, clinical and PTSMA-related characteristics were useful in predicting the PTSMA success rate and its complications. A report on nine-year follow-up results from the SZEGED study revealed that coronary flow velocity reserve (CFR) was an independent predictor of cardiovascular event-free survival for patients with HOCM. 13 However, CFR was estimated by transesophageal echocardiography, which is inconvenient in clinical practice. In the univariate analysis of our study, age, gender, alcohol volume, the number of septal ablations, comorbidities with CAD, hypertension and DM appeared to be associated with the increased occurrence of complications. However, only hypertension, and not the other characteristics, was shown to be a potential factor for predicting complications (OR: 4.856; 95% CI: 1.732-13.609) after multivariate logistic regression analysis. Patients with hypertension were older, showed more significant changes in the echocardiogram, presented with more comorbidities (Table 4). We might present a hypothesis that patients with hypertension had lower cardiac reserve function due tomore cardiovascular risks in this cohort. Hence, this might be the reason why hypertension could be a potential risk factor for PTSMA complications. It is well-known that clinical experience influences the results of a procedure. Similar to results observed from percutaneous coronary interventions, 20 a high-volume load for operators and institutions has been proven to be associated with better procedural outcomes. The importance of a learning curve for PTSMA was confirmed in our study, because a high incidence of late PTSMA failure was noted in the early experience group of patients, whereas this number was significantly reduced with higher experience. At a frequency of approximately 16 treated patients per year, the incidence of late PTSMA complication has been reduced from 41.33% 436