Author + information
- Received June 22, 2017
- Revision received September 8, 2017
- Accepted September 10, 2017
- Published online April 30, 2018.
- Barry J. Maron, MD,
- Ethan J. Rowin, MD,
- James E. Udelson, MD and
- Martin S. Maron, MD∗ ()
- Hypertrophic Cardiomyopathy Institute, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Martin S. Maron, Hypertrophic Cardiomyopathy Institute, Division of Cardiology, Tufts Medical Center, #70, 800 Washington Street, Boston, Massachusetts 02111.
Heart failure (HF), characterized by excessive exertional dyspnea, is a common complication within the broad clinical spectrum of hypertrophic cardiomyopathy (HCM). HF has become an increasingly prominent management issue with the reduction in sudden deaths due to use of implantable defibrillators in this disease. Exertional dyspnea ranges in severity from mild to severe (New York Heart Association functional classes II to IV) and not uncommonly becomes refractory to medical management, leading to progressive disability, but largely in the absence of pulmonary congestion and volume overload requiring hospitalization. HCM-related HF is most commonly due to dynamic mechanical impedance to left ventricular outflow produced by mitral valve systolic anterior motion, leading to high intracavity pressures. Surgical septal myectomy with low operative mortality (<1%) produces HF reversal and symptom relief in 90% to 95% of patients, while also conveying a survival benefit. Exercise echocardiography has assumed an important role in the evaluation of patients with HCM, i.e., by identifying candidates for septal reduction therapy with refractory HF when outflow gradients are present only with physiological exercise, distinguishing highly symptomatic nonobstructive patients as heart transplant candidates, and predicting future development of progressive HF. Notably, mortality directly attributable to HF has become exceedingly uncommon in HCM (<0.5%/year) in contrast with HF in non-HCM diseases (by 20-fold). In conclusion, HF in HCM is associated with diverse and complex pathophysiology, but a substantially more favorable prognosis than conventional non–HCM HF, and highly amenable to effective treatment options in the vast majority of patients.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 22, 2017.
- Revision received September 8, 2017.
- Accepted September 10, 2017.
- 2018 American College of Cardiology Foundation
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