Heart failure & cardiomyopathies
Efficacy of pharmacological therapies in reducing outflow tract obstruction in patients with obstructive hypertrophic cardiomyopathy: a systematic review and meta-analysis
Authors' conclusion
Pharmacological therapies effectively reduced LVOT gradients in oHCM patients to varying degrees, with disopyramide and CMIs showing the highest effect, followed by BBs and CCBs.
Study context
- Population
- Patients with obstructive hypertrophic cardiomyopathy (oHCM)Thirty-seven studies, with 44 arms
- Participants
- 1,898 patients
- Comparison
- Changes in left ventricular outflow tract (LVOT) gradient associated with beta-blockers (BBs), calcium channel blockers (CCBs), disopyramide, or cardiac myosin inhibitors (CMIs)
Methodological detailsrandom-effects model
- Random-effects model
Pooled result
As reported in the abstract
LVOT gradient at rest, by therapeutic class
MD (95% CI)
Disopyramide
−43.5(−51.6 to −35.3)
CMIs
−34.8(−40.6 to −29.0)
BBs
−20.7(−29.4 to −12.0)
CCBs
−14.7(−23.3 to −6.1)
Further pooled results
LVOT gradient reduction within classes
- Within CMIs, mavacamten had a higher effect than aficamten
- Among BBs, metoprolol showed the highest gradient reduction
- Among CCBs, verapamil was the most effective
- Inter-action P < 0.01
Provocable LVOT gradients
- Similar results were observed
Original publication
Efficacy of pharmacological therapies in reducing outflow tract obstruction in patients with obstructive hypertrophic cardiomyopathy: a systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother. Published 16 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it