November 3, 2025Cardiac failure review1 citationsOpen Access
Emerging Pharmacological and Invasive Therapies for Hypertrophic Cardiomyopathy with Obstructive Physiology
Key Result
Cardiac myosin inhibitors directly target sarcomeric hypercontractility to improve symptoms in obstructive hypertrophic cardiomyopathy, while novel minimally invasive septal reduction therapies offer alternatives to surgery.
Structured PICO
P
Population
Patients with hypertrophic cardiomyopathy with obstructive physiology (oHCM)
I
Intervention
Pharmacological therapies (cardiac myosin inhibitors, beta-blockers, calcium channel blockers, disopyramide, emerging agents) and invasive septal reduction therapies
Cardiac myosin inhibitors represent a major advance in oHCM treatment by directly targeting disease pathophysiology, while emerging pharmacological and invasive therapies aim to further refine management and overcome current limitations.
Limitations
- Logistical factors and high costs limit the widespread adoption of cardiac myosin inhibitors.
- Long-term side-effects and outcomes of cardiac myosin inhibitors require ongoing investigation.
- Efficacy of cardiac myosin inhibitors in non-sarcomeric phenocopies or less common variants is unclear.
- Newer invasive techniques like RFA and SESAME have smaller cohorts, shorter follow-up durations, and potentially higher complication rates compared to standard therapies.
Abstract
Hypertrophic cardiomyopathy is a prevalent condition characterised by ventricular hypertrophy, which results in left ventricular outflow obstruction in two-thirds of patients. Traditional pharmacological therapies, including β-blockers, calcium channel blockers and disopyramide, have been the cornerstone of symptom management but lack disease-modifying effects. The introduction of cardiac myosin inhibitors as the first therapy to directly target sarcomeric hypercontractility has dramatically changed clinical practice. However, several logistical factors presently limit the widespread adoption of cardiac myosin inhibitors, and their long-term side-effects and outcomes require ongoing investigation. Emerging pharmacological approaches, including EDG-7500 and gene therapies, aim to refine treatment strategies. For patients with refractory symptoms, invasive septal reduction therapies, including surgical myectomy and alcohol septal ablation, remain critical. Innovations such as radiofrequency ablation and septal scoring along the midline endocardium (SESAME) offer promising, minimally invasive alternatives. As treatment options expand, optimising patient selection, monitoring protocols and long-term outcomes remain essential to advancing care for patients with obstructive hypertrophic cardiomyopathy.
Cite This Study
Chu et al. (Mon,) conducted a review in Hypertrophic cardiomyopathy with obstructive physiology (oHCM). Pharmacological and invasive therapies (cardiac myosin inhibitors, septal reduction therapies) was evaluated. Cardiac myosin inhibitors directly target sarcomeric hypercontractility to improve symptoms in obstructive hypertrophic cardiomyopathy, while novel minimally invasive septal reduction therapies offer alternatives to surgery.