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[Long-term course of hypertrophic cardiomyopathy: drug versus surgical therapy]
Insights
Verapamil improves survival in hypertrophic cardiomyopathy (HCM) patients, especially when combined with septal myectomy (SM). This medical therapy offers survival rates comparable to surgery for HCM management.
Area of Science:
- Cardiology
- Pharmacology
- Surgical Interventions
Background:
- Hypertrophic cardiomyopathy (HCM) is a significant cause of morbidity and mortality.
- Management strategies for HCM include medical therapy and septal myectomy (SM).
- Optimizing long-term outcomes in HCM patients remains a critical clinical challenge.
Purpose of the Study:
- To compare the long-term survival rates of hypertrophic cardiomyopathy patients managed with different therapeutic approaches.
- To evaluate the efficacy of verapamil, propranolol, and no therapy in patients not indicated for septal myectomy.
- To assess the impact of verapamil on survival in patients who underwent septal myectomy.
Main Methods:
- A retrospective follow-up study of 139 patients with hypertrophic cardiomyopathy over a mean of 8.9 years.
- Patients were divided into two groups: those without indication for septal myectomy (Group 1) and those who underwent septal myectomy (Group 2).
- Group 1 was further subdivided into those treated with propranolol, verapamil, or no therapy.
Main Results:
- Overall mortality was 3.6%/year in Group 1 and 2.4%/year in Group 2.
- Ten-year survival rates were 80% for verapamil (Group 1b), 67% for propranolol (Group 1a), and 65% for no therapy (Group 1c).
- Patients treated with verapamil demonstrated significantly higher survival rates (p < 0.05).
- Surgery patients on verapamil had a 100% 10-year survival rate compared to 78% for those not on verapamil (p < 0.05).
Conclusions:
- Septal myectomy generally offers better survival than medical treatment alone for hypertrophic cardiomyopathy.
- Verapamil monotherapy provides survival rates comparable to those achieved with septal myectomy.
- The most favorable long-term outcomes were observed in surgery patients receiving long-term verapamil therapy, likely due to combined effects on systolic and diastolic function.
Abstract:
139 patients with hypertrophic cardiomyopathy (HCM) have been followed up for 1-28 years (mean 8.9 years). Group 1 consisted of 60 patients (mean age 38 years) without indication for septal myectomy (SM) (no pressure gradient at rest in 8, pressure gradient less than 50 mm Hg in 52 cases); group 2 consisted of 79 patients (mean age 36 years) who had SM (pressure gradient at rest 70 mm Hg). Management in group 1 was the following: (1a) propranolol (n = 20) (160 mg/d), (1b) verapamil (n = 18) (360 mg/d) and (1c) no therapy (n = 22). 19 patients died in group 1 (mortality 3.6% year); 17 died in group 2 (mortality 2.4%/year). 10 year survival in group 1b was 80% and in groups 1a und 1c 67% and 65% respectively. Patients of group 1b had a higher survival rate (p less than 0.05) than the other subgroups. Surgery patients treated with verapamil (120-360 mg/d) (n = 17) had a 10-year survival rate of 100% compared to 78% for surgery patients (n = 34) without such treatment (p less than 0.05). In summary, it can be said that the overall survival rate after SM is better than that with medical treatment. Under verapamil, however, survival is not different from that after surgery. The most favorable outcome was observed in surgery patients under long-term therapy with verapamil, probably due to the reduction of systolic pressure overload (SM) and improvement in diastolic function (verapamil).