Does propranolol improve left ventricular hemodynamics in patients with left-sided hypertrophic obstructive cardiomyopathy?
Long-term administration of propranolol in patients with HOCM showed only minor hemodynamic improvements, suggesting surgery remains the primary treatment, though propranolol may offer post-operative benefits.
Abstract. The surgical treatment of left‐sided HOCM is difficult and disappointing. Favourable results of treatment of this disease with beta‐adrenergic blocking drugs have been reported. Therefore the effects on left ventricular haemodynamics of acute and/or long‐term treatment with a beta‐adrenergic blocking drug were studied in eight patients. In some patients only a minor decrease of the left ventriculo‐aortic pressure gradient was found. From these results we concluded that long‐term administration of propranolol in patients with HOCM is of no practical use. One patient, who had been operated upon earlier and was also submitted to the experiments, as hardly any improvement took place after the operation, did improve on treatment with propranolol. From these experiments it was concluded that operation is still the treatment of choice for this disease, bearing in mind however that HOCM is a diffuse myocardiopathy. Treatment with propranolol after operation might improve the effect of operative therapy.
Rookmaker et al. (Tue,) studied this question.