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Review
. 2021 Mar 1;10(5):951.
doi: 10.3390/jcm10050951.

Emerging Medical Treatment for Hypertrophic Cardiomyopathy

Alessia Argirò  1 , Mattia Zampieri  1 , Martina Berteotti  1 , Alberto Marchi  1 , Luigi Tassetti  1 , Chiara Zocchi  1 , Luisa Iannone  2 , Beatrice Bacchi  2 , Francesco Cappelli  1 , Pierluigi Stefàno  2 , Niccolò Marchionni  3 , Iacopo Olivotto  1
Affiliations
Review

Emerging Medical Treatment for Hypertrophic Cardiomyopathy

Alessia Argirò et al. J Clin Med. .

Abstract

Hypertrophic cardiomyopathy (HCM) is a common myocardial disease characterized by otherwise unexplained left ventricular hypertrophy. The main cause of disabling symptoms in patients with HCM is left ventricular outflow tract (LVOT) obstruction. This phenomenon is multifactorial, determined both by anatomical and functional abnormalities: myocardial hypercontractility is believed to represent one of its major determinants. The anatomical anomalies are targeted by surgical interventions, whereas attenuating hypercontractility is the objective of old and new drugs including the novel class of allosteric myosin inhibitors. This review summarizes the current treatment modalities and discusses the emerging therapeutical opportunities focusing on the recently developed cardiac myosin ATPase inhibitors Mavacamten and CK-274. Novel surgical and interventional approaches are also discussed.

Keywords: hypertrophic cardiomyopathy; left ventricular outflow tract obstruction; mavacamten; septal reduction therapy.

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Conflict of interest statement

IO is a consultant for Myokardia and Cytokinetics.

Figures

Figure 1
Figure 1
Structural model of the open on-state and the closed-off state of human beta cardiac myosin. Mavacamten and CK-274 shift the on-off state equilibrium toward the off-folded state, ultimately reducing contractility, in the opposite way Omecamtiv mecarbil stabilizes the open state increasing contractility.
Figure 2
Figure 2
Possible treatment algorithm for obstructive Hypertrophic Cardiomyopathy therapy. HCM: Hypertrophic Cardiomyopathy. * Mavacamten has been submitted for Food and Drugs administration approval. See the text for the flow chart description.
See this image and copyright information in PMC

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