[Conservative medical treatment of hypertrophic myocardiopathies]

50 patients with hypertrophic cardiomyopathy were treated with 480 mg Verapamil per day over a period of 47 months (11-82 months beginning in 1973). Subjective improvement was seen in 37 of 50, 6 were unchanged, 1 worsened, 6 were symptom-free from the beginning and remained so during treatment. Heart size (heart volume determined from chest x-rays in supine position) showed a reduction in 35 of 50. On average of all 50 patients a significant reduction of 8.6% was seen; in 26 patients treated for more than 2 years the average reduction was 11%. 26 patients on no medication or betablockers were followed over 24 months and revealed an average increase in heart volume of 11.9%. The ECG showed during Verapamil treatment a reduction in QRS amplitude and a tendency towards normalization of ST/T segments . . . On echocardiography a small but significant reduction in septal and free wall thickness as well as in left atrial diameter was seen. Recatheterization was performed in 19 patients while all 50 had right and left heart catheters before entering the study. Recatheterization showed on average of the 19 patients a reduction in left ventricular filling pressure, pressure gradient, left ventricular muscle mass and coronary artery diameter. It is concluded that subjective improvement, noninvasive and invasive parameters as well as the low death rate of 1% per year during a total of 200 treatment years point towards a beneficial influence of Verapamil treatment superior to other types of therapy.