Calcium antagonist agents in hypertrophic cardiomyopathy

Calcium antagonists have emerged as important adjuncts to pharmacotherapy of hypertrophic cardiomyopathy. Calcium antagonists cause significant symptomatic improvement in both obstructive and nonobstructive forms and even in patients refractory to beta-blocker therapy. Exercise hemodynamics and exercise tolerance improve in the majority of patients during long-term therapy with calcium antagonists. Reduction in left ventricular (LV) outflow pressure gradient is not consistent after short- or long-term therapy. The provokable gradient tends to remain unchanged. The changes in LV outflow gradient do not appear to be contributory to symptomatic improvement. LV ejection fraction, mean normalized systolic ejection rate and end-systolic pressure volume ratio remain unchanged, suggesting that calcium antagonists agents do not alter LV systolic function. LV diastolic function and its relaxation properties, however, improve in many patients, which might be contributory to symptomatic improvement and improved exercise tolerance.