title: Management strategy in 249 consecutive patients with obstructive hypertrophic cardiomyopathy referred to a dedicated program.
abstract: The likelihood of success of conservative management of obstructive hypertrophic cardiomyopathy (HC) and the predictors of failure of conservative therapy are not known. We therefore evaluated the efficacy of an algorithm for the management of symptoms and predictors of failed conservative therapy in 249 consecutive symptomatic patients with obstructive HC referred to a dedicated HC program for management in general or for septal reduction therapy (SRT) in particular. There was considerable practice variation in the extent to which conservative therapy was optimized before referral for SRT. Over 3.7 ± 2.9-year follow-up, symptoms resolved with addition of or increase in dosage of a β blocker, calcium channel blocker, or disopyramide in 16%, 10%, and 10% of patients, respectively. Pacing with short atrioventricular delay controlled symptoms in 4 of 9 patients. In 63% of patients, conservative measures failed to control symptoms. Multivariate predictors of failure of conservative therapy were presence of New York Heart Association class III or IV symptoms (hazard ratio 2.0, 95% confidence interval 1.4 to 2.9, p = 0.001) and greater septal wall thickness (hazard ratio 1.06, 95% confidence interval 1.02 to 1.10, p = 0.003) at presentation. At time of presentation, 93 patients (37%) were already on optimal therapy and were referred for SRT. Of the remaining 156 patients who did not require immediate SRT, 93 (60%) were free from a recommendation for SRT at the end of the follow-up period. In conclusion, in symptomatic patients with obstructive HC, conservative therapy is successful in >1/3 of referred patients at 3.7-year follow-up, obviating SRT in these patients. Clinicians in programs offering SRT should optimize conservative therapy before recommending SRT.
authors: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, USA. rrothman@partners.org
authors: Richard D
authors: RD
authors: Rothman
authors: Aaron L
authors: AL
authors: Baggish
authors: Caitlin
authors: C
authors: O'Callaghan
authors: Patricia A
authors: PA
authors: Lowry
authors: Ami B
authors: AB
authors: Bhatt
authors: Calum A
authors: CA
authors: MacRae
authors: Gia
authors: G
authors: Yannekis
authors: Danita M
authors: DM
authors: Sanborn
authors: Theofanie
authors: T
authors: Mela
authors: Robert W
authors: RW
authors: Yeh
authors: Igor
authors: I
authors: Palacios
authors: Gus J
authors: GJ
authors: Vlahakes
authors: Michael A
authors: MA
authors: Fifer
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000465:Algorithms; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers