10-year results and survival of patients with hypertrophic cardiomyopathy treated with calcium antagonists

Abstract

Hypertrophic cardiomyopathy is characterized by progredient myocardial hypertrophy causing ventricular systolic and diastolic dysfunction. Long-term results of beta-blocker therapy have been disappointing. Neither the impaired ventricular filling or the prognosis are improved. In contrast, calcium antagonists mainly influence diastolic ventricular dynamics, but also have beneficial effects on systolic function. The results of long-term therapy with calcium antagonists, including patients treated for more than 10 years, are presented here. A total of 84 consecutive patients (mean age 43 years; 20 female and 64 male) with confirmed hypertrophic cardiomyopathy were treated with high doses of calcium antagonists (mean doses of 515 mg verapamil or 158 mg gallopamil per day). In the course of therapy with a mean duration of 52 months, heart size--assessed by X-ray technique--and Sokolow-index in the ECG decreased significantly (heart volume: from 947 to 885 ml/1.73 m2 body surface; Sokolow-index: from 5.0 to 4.5 mV). The echocardiogram showed a significant decrease in left atrial diameter, whereas wall thickness only tended to decrease. Hemodynamic control investigations confirmed an improvement in systolic as well as in diastolic ventricular function (mean follow-up period was 31 months). According to these findings the condition and stress tolerance improved in 84% of the patients. Therapy with calcium antagonists also improved prognosis: without treatment or following treatment with beta-blocking agents, annual mortality is approximately 3.5%, whereas in the described patient population mortality dropped to less than 2%. Thus, a calcium antagonist is the medication of first choice for patients with hypertrophic cardiomyopathy.