Heart failure & cardiomyopathies
Current Therapies for Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis of the Literature
Authors' conclusion
Invasive septal reduction therapies increase VO2max, improve symptomatic status, and reduce resting and peak LVOT gradient, thus might be considered in obstructive patients. Physical exercise emerges as a coadjuvant therapy, which is safe and associated with benefits on functional capacity. Pharmacological agents improve reported NYHA class, but not functional capacity.
Study context
- Population
- Patients with hypertrophic cardiomyopathy (HCM)41 studies
- Comparison
- Pharmacological vs invasive vs physical exercise therapies
- Outcome
- Functional capacity (VO2max)
Pooled result
As reported in the abstract
Pharmacological
1.11
95% CI −0.04–2.25 · mL/kg/min
Invasive
+3.2
95% CI 1.78–4.60 · mL/kg/min
Physical exercise
+ 4.33
95% CI 0.20–8.45 · mL/kg/min
- Pharmacological agents had no effect on VO2max
- P < 0.05
- Invasive septal reduction increased VO2max
- P < 0.05
- Exercise: highest increase in VO2max
- P < 0.05
Further pooled results
| Outcome | P value |
|---|---|
| VO2max, by resting LVOT obstruction (subgroup)LVOT obstruction at rest vs No resting LVOT obstruction · 2.82 (95% CI 1.97, 3.67) vs 1.18 (95% CI 0.62, 1.74) | P < 0.05 |
Peak left ventricular outflow tract (LVOT) gradient
- Reduced with all three options; greatest reduction with invasive therapies
LVEF
- Reduced with pharmacological and invasive procedures; no effect after physical exercise
Symptomatic status
- Improved with all three options, most with invasive procedures
Original publication
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