Cited by 178Cardiomyopathy and Myosin StudiesViral Infections and Immunology ResearchCardiac Valve Diseases and Treatments

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Treatment of Obstructive Hypertrophic Cardiomyopathy Symptoms and Gradient Resistant to First-Line Therapy With β-Blockade or Verapamil

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Sherrid, Mark V., Shetty, Aneesha, Winson, Glenda, Kim, Bette, Musat, Dan, Alviar, Carlos L., Homel, Peter, Balaram, Sandhya K., Swistel, Daniel G.·2013·Circulation Heart Failure

DOI 10.1161/circheartfailure.112.000122

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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.

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“Nevertheless, we continue the surveillance described above in our disopyramide-treated patients.(3,7) We”
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Authors: Sherrid, M. V., Shetty, A., Winson, G., Kim, B., Musat, D., Alviar, C. L., Homel, P., Balaram, S. K., & Swistel, D. G.
Affiliations: St. Luke's-Roosevelt Hospital Center (US)
ORCID: Sherrid, Mark V.
Shetty, Aneesha
Musat, Dan
Alviar, Carlos L.
Balaram, Sandhya K.
Swistel, Daniel G.
Venue: Circulation Heart Failure
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2013-07
Volume: 6
Issue: 4
Pages: 694-702
ISSN: 1941-3289 (ISSN-L)
1941-3297
DOI: 10.1161/circheartfailure.112.000122
OpenAlex: W2122819292
Cited by: 178
References: 33
Citations by year: 2026: 11 · 2025: 26 · 2024: 26 · 2023: 12 · 2022: 14 · 2021: 13 · 2020: 11 · 2019: 6 · 2018: 13 · 2017: 7 · 2016: 14 · 2015: 10 · 2014: 13 · 2013: 1
FWCI: 8.65
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation Heart Failure (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
Keywords: hypertrophic obstructive cardiomyopathy, left ventricular outflow tract obstruction, disopyramide, beta-adrenergic blockade, verapamil, myectomy, alcohol septal ablation, symptom relief, survival, sudden death
MeSH terms: Adrenergic beta-Antagonists, Aged, Anti-Arrhythmia Agents, Calcium Channel Blockers, Cardiomyopathy, Hypertrophic, Combined Modality Therapy, Disopyramide, Female, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Verapamil, Treatment Failure

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Treatment of Obstructive Hypertrophic Cardiomyopathy Symptoms and Gradient Resistant to First-Line Therapy With β-Blockade or Verapamil

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