Comment: Hypertrophic Cardiomyopathy is a common genetic cardiac disease. Most of the patients with Hypertrophic Cardiomyopathy have the outflow tract of the left ventricle of their heart obstructed by the combination of the hypertrophied interventricular septum and the dynamic systolic anterior movement of the mitral valve. This a complex phenomenon, which is contributed to by anatomical, geometrical and flow factors. The left ventricular outflow tract obstruction is responsible for a variety of limiting symptoms and features in the sudden death risk algorithm too. Its medical management has been limited by reduced efficacy and side effects and the invasive management requires a high volume of experience and is therefore not widely available. In this clinical context, Mavacamten, a myosin inhibitor, is generating new hope for a tailored medical management of the obstructive Hypertrophic Cardiomyopathy. Some questions remain to be addressed, and including how Mavacamten should be used and how efficient will it be in different clinical scenarios, given the heterogeneous phenotype of these patients.
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