Management of hypertrophic cardiomyopathy

Abstract

Hypertrophic cardiomyopathy is an important cause of heart failure and arrhythmias, including sudden death, with a major impact on the healthcare system. Genetic causes and different phenotypes are now increasingly being identified for this condition. In addition, specific medications, such as myosin inhibitors, have been recently shown as potentially able to modify its symptoms, hemodynamic abnormalities and clinical course. Our article aims to provide a comprehensive outline of the epidemiology, diagnosis and treatment of hypertrophic cardiomyopathy in the current era.

Fig. 1

Diagnostic algorithm for hypertrophic cardiomyopathy (CMR, cardiac magnetic resonance; ECG, electrocardiography; HCM, hypertrophic cardiomyopathy; SCD, sudden cardiac death).

Fig. 2

Flow chart for genetic testing and family screening in hypertrophic cardiomyopathy (B/LB, benign/likely benign; HCM, hypertrophic cardiomyopathy; P/LP, pathogenic/likely pathogenic; VUS, variant of unknown significance).

Fig. 3

Flow chart for treatment of patients with hypertrophic cardiomyopathy (CCB, calcicum channel blocker; CRT, cardiac resynchronization therapy; GDMT, guideline-directed medical therapy; HCM, hypertrophic cardiomyopathy; HFpEF, heart failure with preserved ejection fraction; ICD, implantable cardioverter defibrillator; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association).

Fig. 4

Flow chart for selection of ICD implantation population in patients with hypertrophic cardiomyopathy (HCM, hypertrophic cardiomyopathy; ICD, implantable cardioverter defibrillator; LVEF, left ventricular ejection fraction; SCD, sudden cardiac death).