The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index; 6 of the 20 sources its claims cite were checked for support.
Discontinuation of afterload-reducing drugs decreases left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy
Open accessAbstract
Background: Hypertrophic cardiomyopathy (HCM), the most common genetic heart disease, is classified into hypertrophic non-obstructive and hypertrophic obstructive cardiomyopathy (HOCM). Patients with HOCM and coexisting heart failure or arterial hypertension are often prescribed afterload-reducing drugs. Although recommended in current guidelines, data on the direct effect of discontinuing afterload-reducing medication are scarce. This study aims to demonstrate the benefit of discontinuing afterload-reducing medication in HOCM patients. Methods: This monocentric retrospective analysis included 24 patients with HOCM with afterload-reducing medication, including angiotensin-converting enzyme inhibitors, angiotensin-1 receptor blocker and dihydropyridine-calcium channel blocker, at their first outpatient visit. Effects of discontinuing this medication on LVOTO were examined compared to patients with persistent use despite medical advice. Results: 16 patients discontinued their afterload-reducing drugs, resulting in a significant decrease in median LVOT gradient from 86.5 [60.5–109.3] mmHg to 61.5 [28.3–97.50] mmHg ( p = 0.0004). In 6 patients, beta-blocker therapy was initiated simultaneously, or the dose was increased. Regardless, LVOT gradient reduction was also significant in the remaining 10 patients ( p = 0.001). The gradient was not changed significantly in the 8 patients continuing their afterload-reducing medication. Conclusions: Discontinuation of afterload-reducing drugs significantly decreases LVOTO. Our study underscores the significance of abstaining from afterload-reducing drugs in HOCM patients, particularly in patients with concomitant hypertension or heart failure. According to recently published European guidelines, HOCM patients should preferably be treated with beta-blockers or non-dihydropyridine-calcium channel blockers.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In a monocentric retrospective cohort of 24 HOCM patients with arterial hypertension, discontinuing afterload-reducing drugs significantly reduced the LVOT gradient, while continuation showed no significant change. The authors conclude that afterload-reducing drugs should be avoided in HOCM and that beta-blockers or non-dihydropyridine calcium channel blockers are preferred.
Key findings
- Among 16 patients who discontinued afterload-reducing medication, median LVOT gradient fell from 86.5 [60.5–109.3] mmHg to 61.5 [28.3–97.5] mmHg (p = 0.0004), with a mean reduction of 31.7 ± 33.8 mmHg.
- In the 10 patients who did not simultaneously start or increase a beta-blocker, LVOT gradient reduction remained significant (p = 0.001); adding or increasing a beta-blocker had no significant impact on gradient change (p = 0.23).
- In 8 patients who continued afterload-reducing medication against medical advice, median LVOT gradient changed from 56.5 [41.5–63.3] mmHg to 67.5 [46.5–79.8] mmHg, a mean increase of 14.2 ± 23.8 mmHg (p = 0.14); between-group difference in gradient change was significant (p = 0.0024).
- By drug class, ACEi discontinuation produced a significant median LVOT gradient reduction of −36.8 mmHg; ARB discontinuation reduced gradient in 3/4 patients (median −30.1 mmHg) and CCB-DHP discontinuation in 4/5 patients (median −22.1 mmHg), but these subgroup reductions were not statistically significant.
Methods
- Monocentric retrospective analysis at the special outpatient clinic for cardiomyopathies at Hannover Medical School, including 24 HOCM patients with afterload-reducing medication (ACEi, ARB, or dihydropyridine calcium channel blocker) at first outpatient visit; 16 discontinued and 8 continued the medication.
- Diagnosis of HCM followed ESC criteria; LVOTO was defined as an instantaneous peak Doppler LVOT pressure gradient ≥30 mmHg at rest or during physiological provocation. Echocardiography assessed LVOT gradient, IVSd, LA PLAX, LVEDD, LV mass, LV mass-index, mitral regurgitation, and diastolic function.
- Continuous variables were compared with Wilcoxon or paired t-tests, unpaired comparisons with Mann-Whitney U or t-tests, and categorical variables with Chi-square or Fisher’s exact test; significance was p < 0.05.
Limitations
- The paper states that a primary limitation is the small number of cases, partly because patients are often advised to discontinue afterload-lowering therapy even before further assessment.
- The text makes evident that this is a retrospective, monocentric, non-randomized observational study with a small sample, small drug-class subgroups, and continuation patients who took medication against medical advice.
- The paper reports no statistically significant changes in symptoms such as NYHA class, syncope, or palpitations, and notes that this is most likely due to the small number of patients; it also notes a slight non-significant blood pressure increase after discontinuation, so blood pressure should be monitored regularly.
Model-written summary. Check it against the paper before relying on it.
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Statistics
Verification
Claims the paper makes
6 of 20 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured
- Findingown data
Addition or dose increase of a beta-blocker had no significant impact on the change in LVOT gradient (p = 0.23).
“A comparison between HOCM patients with and without addition or dose increase of a beta-blocker revealed that this had no significant impact on the change in the LVOT gradient (p = 0.23)”
Quote in the paperNot a substantial claim - Findingown data
Other echocardiographic parameters (IVSd, LA PLAX, LVEDD, LV mass, LV mass-index, mitral valve regurgitation, diastolic dysfunction) did not change significantly between outpatient visits.
“Other echocardiographic parameters such as IVSd, LA PLAX, LVEDD, LV mass, LV mass-index, mitral valve regurgitation or diastolic dysfunction did not change significantly between outpatient visits.”
Quote in the paperNot a substantial claim - Findingown data
The mean LVOT gradient reduction after discontinuation was 31.7 ± 33.8 mmHg.
“This represents a mean LVOT gradient reduction of 31.7 ± 33.8 mmHg.”
Quote in the paperSubstantial claim - Findingown data
At baseline, the discontinuation group had a higher LA PLAX than the continuation group (45.6 ± 5.8 vs 39.3 ± 5.5 mm, p = 0.02).
“LA PLAX (mm) | 45.6 ± 5.8 | 39.3 ± 5.5 | 0.02”
Quote in the paperNot a substantial claim - Findingown data
Discontinuation of afterload-reducing medication resulted in a significant decrease in median LVOT gradient from 86.5 [60.5-109.3] mmHg to 61.5 [28.3-97.5] mmHg (p = 0.0004).
“16 patients discontinued their afterload-reducing drugs, resulting in a significant decrease in median LVOT gradient from 86.5 [60.5–109.3] mmHg to 61.5 [28.3–97.50] mmHg (p = 0.0004).”
- Also stated in: § Results · plain
“Discontinuation of afterload-reducing medication resulted in a significant decrease in median LVOT gradient from 86.5 [60.5–109.3] mmHg to 61.5 [28.3–97.5] mmHg (p = 0.0004) (Table 1 and Figure 1A).”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
Symptoms such as dyspnea (NYHA classification), syncope and palpitations did not change significantly in either group.
“Similarly, symptoms such as dyspnea, assessed by the NYHA classification, syncope and palpitations did not change significantly in either group (Table 2).”
Quote in the paperNot a substantial claim - Findingown data
Discontinuation of ACE inhibitors led to a significant reduction in LVOT gradient, with a median reduction of −36.8 mmHg.
“Discontinuation of ACEis leads to a significant reduction in LVOT gradient, with a median reduction of −36.8 mmHg (Figure 3C).”
Quote in the paperSubstantial claim - Findingown data
At baseline, the discontinuation group had a higher median LVOT gradient than the continuation group (86.5 [60.5-109.3] vs 56.5 [41.5-63.3] mmHg, p = 0.02).
“LVOT gradient max. (mmHg) | 86.5 [60.5–109.3] | 56.5 [41.5–63.3] | 0.02”
Quote in the paperNot a substantial claim - Findingown data
Change in systolic and diastolic blood pressure did not differ significantly between the discontinuation and continuation groups.
“Change in systolic (p = 0.12) and diastolic (p = 0.94) blood pressure did not differ between both patient groups.”
Quote in the paperNot a substantial claim - Findingown data
In the subgroup of patients who did not start or increase beta-blocker therapy, discontinuation of afterload-reducing medication was associated with a significant reduction in LVOT gradient (p = 0.001).
“Regardless, LVOT gradient reduction was also significant in the remaining 10 patients (p = 0.001).”
- Also stated in: § Results · plain
“Again, a significant reduction in LVOT gradient was achieved (p = 0.001).”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
In patients who continued afterload-reducing medication, the LVOT gradient did not change significantly (median increased from 56.5 [41.5-63.3] mmHg to 67.5 [46.5-79.8] mmHg, p = 0.14).
“The gradient was not changed significantly in the 8 patients continuing their afterload-reducing medication.”
- Also stated in: § Results · hedged
“Continuation of afterload-reducing medication resulted in a tendency towards a slight increase in median LVOT gradient from 56.5 [41.5–63.3] mmHg to 67.5 [46.5–79.8] mmHg by a mean of 14.2 ± 23.8 mmHg (p = 0.14) (Table 1 and Figure 1B).”
Quote in the paperSubstantial claim - Also stated in: § Results · hedged
- Findingown data
The change in LVOT gradient between visits differed significantly between the discontinuation and continuation groups (p = 0.0024).
“Apart from the change in medication and the associated reduction in the LVOT gradient (p = 0.0024), no parameters such as blood pressure, LVEDD, IVSd or mitral regurgitation developed significantly differently between the two patient groups.”
Quote in the paperSubstantial claim- Rests on an assumption: The discontinuation and continuation groups are comparable enough that the difference in LVOT gradient change can be attributed to medication discontinuation.
- Study design and conductreasoning
A primary limitation of this study is the small number of cases.
“A primary limitation of this study is the small number of cases.”
Quote in the paperNot a substantial claim - Interpretationown data
The observed reduction in LVOT gradient after discontinuation was primarily seen with discontinuation of ACE inhibitors, both in numerical differences and magnitude of effect.
“The observed reduction in the LVOT gradient after discontinuation was primarily seen by the discontinuation of ACEis, both in terms of numerical differences and magnitude of effect.”
Quote in the paperSubstantial claim - Interpretationown data
Discontinuation of afterload-reducing drugs significantly decreases LVOTO in HOCM patients.
“Discontinuation of afterload-reducing drugs significantly decreases LVOTO.”
- Also stated in: § Conclusion · plain
“Despite the relatively small number of patients included in the study, the results show that simple changes in therapy can significantly reduce LVOTO in patients with HOCM.”
Quote in the paperSubstantial claim- Rests on an assumption: The observed changes in LVOT gradient between visits are attributable to the discontinuation of afterload-reducing medication rather than to other temporal factors or confounders.
- Rests on an assumption: The discontinuation and continuation groups are comparable enough that the difference in LVOT gradient change can be attributed to medication discontinuation.
- Also stated in: § Conclusion · plain
- Interpretationreasoning
This vasodilation mechanism can exacerbate the LVOT gradient in HOCM patients.
“This mechanism poses a challenge for patients with HOCM since the obstruction increases pressure within the left ventricle and decreases it behind the aortic valve and therefore can exacerbate the LVOT gradient.”
Quote in the paperSubstantial claim - Interpretationown data
The lack of statistically significant LVOT gradient reduction in the ARB and CCB-DHP subgroups may be attributed to the small number of cases.
“No significant reduction in LVOT gradient was observed in those subgroups (CCB-DHP, ARB), although this may be attributed to the small number of cases.”
Quote in the paperNot a substantial claim - Interpretationcitation
Mechanistically, the reduction in LVOTO observed in this study could significantly impact cardiac function.
“Mechanistically, the reduction in left ventricular outflow tract obstruction (LVOTO) observed in our study could significantly impact cardiac function.”
Quote in the paperNot a substantial claim
- Probably not a substantial claim. 15
- It may state two separate claims as one. 7
Probably not a substantial claim.
Study design and conductcitationThe diagnosis of HCM was based on the latest ESC guidelines for the diagnosis and management of hypertrophic cardiomyopathies.
“The diagnosis of HCM was based on the latest ESC guidelines for the diagnosis and management of hypertrophic cardiomyopathies: patients with familial or genetically diagnosed HCM with wall thickness ≥13 mm in one or more left ventricular myocardial segments or patients with wall thickness ≥15 mm in the absence of any other cause of hypertrophy (7, 8).”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [7] Elliott, 2014, 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC), Eur Heart J source
Section 5.1.1 (Adults; page unavailable) supports the ≥15 mm threshold for adults when wall thickening is not explained by loading conditions. Section 5.1.3 (Relatives; page unavailable) supports ≥13 mm only for first-degree relatives of patients with unequivocal HCM, when the thickening is otherwise unexplained. The citing sentence extends that lower threshold to genetically diagnosed patients without those qualifications. (LLM, conf=0.83)
Experimental — accuracy not yet measured - cites [8] Arbelo, 2023, 2023 ESC guidelines for the management of cardiomyopathies, Eur Heart J source
Checked before — its earlier verdict is held back until a new check runs.
Probably not a substantial claim.
PremisecitationCurrent guidelines do not recommend ACE inhibitors, ARBs and dihydropyridine calcium channel blockers for HOCM.
“Therefore, current guidelines do not recommend these three classes of drugs for HOCM (6, 7).”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [6] Ommen, 2020, 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines, Circulation source
- cites [7] Elliott, 2014, 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC), Eur Heart J source
Section 9.1.2 explicitly says dihydropyridine calcium antagonists are not recommended for treating left ventricular outflow tract obstruction (LVOTO). Section 9.1.1 advises avoiding arterial and venous dilators in patients with LVOTO if possible, but does not specifically name ACE inhibitors or ARBs or give them an unqualified prohibition. Section 9.3.1.1 recommends considering ACE inhibitors or ARBs for patients without LVOTO who have reduced ejection fraction. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Probably not a substantial claim. The paper’s conclusions may not depend on it.
Study design and conductcitationEchocardiography was performed according to the recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
“Echocardiography was performed according to the recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging (14–16).”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [14] Nagueh, 2016, Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging, J Am Soc Echocardiogr source
- cites [15] Cheitlin, 2003, ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography), J Am Soc Echocardiogr source
- cites [16] Lang, 2015, Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging, J Am Soc Echocardiogr source
Probably not a substantial claim.
PremisecitationCurrent ESC and ACC guidelines recommend anti-obstructive therapy (beta-blockers or verapamil) to reduce gradient and symptoms in HOCM.
“Current guidelines from the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) recommend anti-obstructive therapy, i.e., beta-blockers or verapamil to reduce gradient and symptoms (6–8).”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [6] Ommen, 2020, 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines, Circulation source
- cites [7] Elliott, 2014, 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC), Eur Heart J source
- cites [8] Arbelo, 2023, 2023 ESC guidelines for the management of cardiomyopathies, Eur Heart J source
Probably not a substantial claim. The paper’s conclusions may not depend on it.
Findingown dataThere were no significant differences between the discontinuation and continuation groups regarding cardiovascular risk factors such as increased BMI or diabetes.
“There were no significant differences between the two groups with regard to cardiovascular risk factors such as an increased body mass index (BMI) or diabetes.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Findingown dataOne patient continued CCB-DHP but discontinued ACE inhibitors.
“One patient continued to take CCB-DHP but discontinued ACEis.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Findingown dataAll patients in the discontinuation group discontinued ACE inhibitor therapy (100%).
“Table 2 shows that 100% of patients discontinued their ACEi therapy.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Findingown dataThe study included 24 HOCM patients with concomitant arterial hypertension.
“A total of 24 HOCM patients with concomitant AH were included in the analysis.”
Quote in the paperNot a substantial claimIt may state two separate claims as one.
Findingown dataIn patients who discontinued ARBs, LVOT gradient was reduced at follow-up in 3/4 of patients (median −30.1 mmHg), but the reduction was not statistically significant.
“The LVOT gradient was reduced at follow-up in 3/4 of patients who stopped ARBs (median = −30.1 mmHg) and 4/5 of patients who stopped CCB-DHPs (median = −22.1 mmHg). Nevertheless, the reduction was not statistically significant probably due to the low number of patients.”
Quote in the paperSubstantial claimIt may state two separate claims as one.
Findingown dataIn patients who discontinued CCB-DHPs, LVOT gradient was reduced at follow-up in 4/5 of patients (median −22.1 mmHg), but the reduction was not statistically significant.
“The LVOT gradient was reduced at follow-up in 3/4 of patients who stopped ARBs (median = −30.1 mmHg) and 4/5 of patients who stopped CCB-DHPs (median = −22.1 mmHg). Nevertheless, the reduction was not statistically significant probably due to the low number of patients.”
Quote in the paperSubstantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Findingown dataThe median interval between the two outpatient visits did not differ significantly between the discontinuation and continuation groups (193 [113-339] vs 166 [47-365] days, p = 0.52).
“The median interval between the two outpatient visits was 193 [113–339] days in the cohort that discontinued afterload-reducing medication and 166 [47–365] days in the group that continued medication, and was not statistically significant (p = 0.52).”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Findingown dataA significantly higher proportion of patients who continued afterload-reducing medication were smokers compared with those who discontinued (p = 0.02).
“Conversely, a significant higher proportion of patients who did not stop afterload-reducing medication were smokers (p = 0.02).”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Findingown dataThere was a clear but not statistically significant increase in patients who started mineralocorticoid receptor antagonist therapy (p = 0.12).
“There was also a clear but not significant increase in patients who started therapy with a mineralocorticoid receptor antagonist (MRA) (p = 0.12).”
Quote in the paperNot a substantial claimIt may state two separate claims as one.
Findingown data16 of 24 patients (66.7%) discontinued afterload-reducing medication, and 8 (33.3%) continued it against medical advice.
“16 patients (66.7%) discontinued afterload-reducing medication; the remaining 8 (33.3%) continued taking it against medical advice.”
- Also stated in: § Results · plain
“16 patients discontinued their afterload-reducing drugs, resulting in a significant decrease in median LVOT gradient from 86.5 [60.5–109.3] mmHg to 61.5 [28.3–97.50] mmHg (p = 0.0004).”
Quote in the paperSubstantial claim- Also stated in: § Results · plain
Probably not a substantial claim. The paper’s conclusions may not depend on it.
PremisecitationACE inhibitors and ARBs have been shown to significantly improve adverse remodeling in heart failure patients.
“Furthermore, ACEis and ARBs have convincingly been shown to significantly improve adverse remodeling in HF patients (9–11).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [9] Correale, 2022, Pharmacological anti-remodelling effects of disease-modifying drugs in heart failure with reduced ejection fraction, Clin Drug Investig source
- cites [10] Cohn, 2000, Cardiac remodeling–concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an international forum on cardiac remodeling, J Am Coll Cardiol source
Checked before — its earlier verdict is held back until a new check runs.
- cites [11] McKelvie, 1999, Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD pilot study investigators, Circulation source
Checked before — its earlier verdict is held back until a new check runs.
Probably not a substantial claim. It may state two separate claims as one.
PremisecitationAlleviating LVOTO could lower wall tension, thereby reducing myocardial oxygen consumption and positively affecting left atrial pressure and remodeling.
“It has been suggested that alleviating LVOTO could lower wall tension, thereby reducing myocardial oxygen consumption and positively affecting left atrial pressure and remodeling (38, 39).”
Quote in the paperSubstantial claim0 of 2 sources checkedProbably not a substantial claim. The paper’s conclusions may not depend on it.
PremisecitationIndividuals with HCM often have concomitant arterial hypertension, with an incidence rate of 37%.
“Moreover, individuals with HCM often have concomitant AH, a phenomenon described in a previous study with an incidence rate of 37% (21).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [21] Lopes, 2022, Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational research programme (EORP) cardiomyopathy/myocarditis registry, Eur Heart J Qual Care Clin Outcomes source
Checked before — its earlier verdict is held back until a new check runs.
It may state two separate claims as one.
InterpretationreasoningThese physiological changes may improve the metabolic profile and overall cardiac function in HCM patients with obstructive physiology.
“These physiological changes may improve the metabolic profile and overall cardiac function in hypertrophic cardiomyopathy (HCM) patients and associated obstructive physiology.”
Quote in the paperSubstantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
PremisecitationAmong the 'fantastic four' medications used to treat heart failure, drugs that lower afterload are an essential component.
“Among the “fantastic four” medication used to treat heart failure, drugs that lower afterload are an essential component (12).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] Rossignol, 2019, Heart failure drug treatment, Lancet source
Checked before — its earlier verdict is held back until a new check runs.
It may state two separate claims as one.
PremisecitationACE inhibitors, ARBs and dihydropyridine calcium channel blockers cause vasodilation and reduce arterial blood pressure by reducing total peripheral resistance.
“ACEis and ARBs, as well as CCB-DHP cause vasodilation and, thus, a reduction in arterial blood pressure by reducing total peripheral resistance (36, 37).”
Quote in the paperSubstantial claim0 of 2 sources checkedIt may state two separate claims as one.
InterpretationcitationSystemic administration of ACE inhibitors worsens outflow tract obstruction, leading to increased LVOT gradient.
“These results are consistent with our observations, indicating that systemic administration of ACEis worsens outflow tract obstruction, leading to increased LVOT gradient.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [32] Kyriakidis, 1998, Effects of cardiac versus circulatory angiotensin-converting enzyme inhibition on left ventricular diastolic function and coronary blood flow in hypertrophic obstructive cardiomyopathy, Circulation source
The paper relies on this without support.
Data on the direct effect of discontinuing afterload-reducing medication in HOCM are scarce.
“Although recommended in current guidelines, data on the direct effect of discontinuing afterload-reducing medication are scarce.”
“However, there is limited data available on the direct effect of such discontinuation on the LVOTO.”
The paper relies on this without support.
The observed changes in LVOT gradient between visits are attributable to the discontinuation of afterload-reducing medication rather than to other temporal factors or confounders.
“Discontinuation of afterload-reducing drugs significantly decreases LVOTO.”
The paper relies on this without support.
The discontinuation and continuation groups are comparable enough that the difference in LVOT gradient change can be attributed to medication discontinuation.
“Apart from the change in medication and the associated reduction in the LVOT gradient (p = 0.0024), no parameters such as blood pressure, LVEDD, IVSd or mitral regurgitation developed significantly differently between the two patient groups.”
The paper relies on this without support.
HOCM patients with arterial hypertension or heart failure are often inadvertently prescribed afterload-reducing drugs.
“The coexistence of AH in a significant proportion of HOCM patients often leads to inadvertent administration of afterload-reducing drugs, worsening the LVOTO.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
ACE-inhibitor result cites the ARB panel
MinorThe results attribute the ACE-inhibitor reduction to Figure 3C, but the figure caption identifies panel C as ARB discontinuation and panel A as ACEi discontinuation.
“Discontinuation of ACEis leads to a significant reduction in LVOT gradient, with a median reduction of −36.8 mmHg (Figure 3C).”
“(A) ACEi discontinuation (n = 10), (B) CCB-DHP discontinuation (n = 5), (C) ARB discontinuation (n = 4).”
Reported delta uses the opposite subtraction order
MinorThe paper says Table 2 subtracts the second-visit value from the first, but it reports a negative mean LVOT-gradient delta for the group whose gradient decreased. That delta instead reflects second visit minus first visit.
“For this purpose, the values of the second visit were subtracted from those of the first visit to present the differences.”
“Δ LVOT gradient max. (mmHg) | −31.7 ± 33.8 | 14.2 ± 23.8 | 0.0024”
Citations
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Kardiovaskuläre Pharmakotherapie im Zeitalter RNA-basierter Präzisionsmedizin
Derda, A. A., & Hohneck, A. L. (2026) · Herz · doi:10.1007/s00059-026-05375-9
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Deprescribing of beta-blocker and RAAS inhibitors in heart failure patients: A narrative review
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Metadata
- Authors
- Derda, A. A., Abelmann, M., Sonnenschein, K., Sieweke, J.-T., Bavendiek, U., Bauersachs, J., Thum, T., & Berliner, D.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Berliner, Dominik
- ORCID
- Venue
- Frontiers in Cardiovascular Medicine
- Publisher
- Frontiers Media SA
- Published
- 2024-07-16
- Volume
- 11
- Pages
- 1403422-1403422
- ISSN
- 2297-055X (ISSN-L)
- PMC
- PMC11286422
- OpenAlex
- W4400695771
- Semantic Scholar
- 124d6884184a27f6f5b37481cc999f4e93844374
- Cited by
- 6
- References
- 40
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Cardiovascular Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- hypertrophic obstructive cardiomyopathy, left ventricular outflow tract obstruction, drug discontinuation, ACE inhibitors, dihydropyridine calcium channel blockers, beta-blockers, heart failure, hypertension, left ventricular outflow tract gradient
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-11-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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