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Has 'obstruction' hindered our understanding of hypertrophic cardiomyopathy?

J M Criley, R J Siegel

    Circulation
    |December 1, 1985
    PubMed

    Insights

    Hypertrophic cardiomyopathy (HCM) treatment should focus on managing symptoms and preventing sudden death, rather than solely on relieving outflow obstruction. New approaches emphasize improving ventricular relaxation and diastolic filling for better patient outcomes.

    Area of Science:

    • Cardiology
    • Cardiovascular Medicine
    • Pathophysiology

    Background:

    • Hypertrophic cardiomyopathy (HCM) is a significant cause of morbidity, mortality, and sudden cardiac death.
    • Historically, HCM management focused on relieving outflow tract obstruction due to symptom similarity with aortic stenosis.
    • This obstructive dogma may have hindered understanding and effective treatment of HCM.

    Purpose of the Study:

    • To highlight discrepancies in the traditional obstructive concept of HCM.
    • To re-evaluate the definition and significance of obstruction in HCM.
    • To propose a refined understanding of HCM pathophysiology and therapeutic targets.

    Main Methods:

    • Review of existing literature and clinical observations.
    • Analysis of discrepancies between obstructive theories and emerging data.
    • Comparison of HCM manifestations with other conditions like aortic stenosis.

    Main Results:

    • Neither a pressure gradient nor systolic anterior motion (SAM) definitively equates to obstruction in HCM.
    • The term "obstruction" should be reserved for cases with demonstrably impeded ventricular outflow or emptying.
    • Beta-blockers and calcium channel blockers improve symptoms and diastolic function without consistently reducing gradients.
    • Antiarrhythmic therapy effectively reduces mortality in HCM patients.

    Conclusions:

    • The focus on obstruction in HCM may be misplaced, potentially impeding progress.
    • Therapies improving ventricular relaxation and diastolic filling show promise.
    • Future interventions should prioritize preventing or reversing pathologic hypertrophy.
    • Effective management involves symptom alleviation, mortality reduction, and addressing underlying pathophysiology.

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