Treatment of obstructive hypertrophic cardiomyopathy symptoms and gradient resistant to first-line therapy with β-blockade or verapamil

Mark V. Sherrid*, Aneesha Shetty, Glenda Winson, Bette Kim, Dan Musat, Carlos L. Alviar, Peter Homel, Sandhya K. Balaram, Daniel G. Swistel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

62 Scopus citations

Abstract

Background-There is controversy about preferred methods to relieve obstruction in hypertrophic cardiomyopathy patients still symptomatic after β-blockade or verapamil. Methods and Results-Of 737 patients prospectively registered at our institution, 299 (41%) required further therapy for obstruction for limiting symptoms, rest gradient 61±45, provoked gradient 115±49 mm Hg, and followed up for 4.8 years. Disopyramide was added in 221 (74%) patients and pharmacological control of symptoms was achieved in 141 (64%) patients. Overall, 138 (46%) patients had surgical relief of obstruction (91% myectomy) and 6 (2%) alcohol septal ablation. At follow-up, resting gradients in the 299 patients had decreased from 61±44 to 10±25 mm Hg (P<0.0001); New York Heart Association class decreased from 2.7±0.7 to 1.8±0.5 (P<0.0001). Kaplan-Meier survival at 10 years in the 299 advanced-care patients was 88% and did not differ from nonobstructed patients (P=0.28). Only 1 patient had sudden death, a low annual rate of 0.06%/y. Kaplan-Meier survival at 10 years in the advanced-care patients did not differ from that expected in a matched cohort of the US population (P=0.90). Conclusions-Patients with obstruction and symptoms resistant to initial pharmacological therapy with β-blockade or verapamil may realize meaningful symptom relief and low mortality through stepped management, adding disopyramide in appropriately selected patients, and when needed, by surgical myectomy.

Original languageEnglish (US)
Pages (from-to)694-702
Number of pages9
JournalCirculation: Heart Failure
Volume6
Issue number4
DOIs
StatePublished - Jul 1 2013

Keywords

  • Cardiac surgical procedures
  • Cardiomyopathy, hypertrophic
  • Disopyramide
  • Drug therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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