Key result
Metoprolol cuts resting LVOT gradients ~65% vs placebo, while verapamil shows variable hemodynamic effects.
Why the study?
This study aims to establish the therapeutic value and benefits of metoprolol or verapamil in symptomatic HCM, regarding LVOTO resolution, symptom reduction, and quality of life improvement.
Does metoprolol or verapamil improve left ventricular outflow tract obstruction and symptoms in patients with hypertrophic cardiomyopathy?
Systematic Review (n=159)
Does metoprolol or verapamil improve left ventricular outflow tract obstruction and symptoms in patients with hypertrophic cardiomyopathy?
Absolute Event Rate: 25% vs 72%
p-value: p=0.007
In patients with hypertrophic cardiomyopathy, metoprolol effectively reduces left ventricular outflow tract gradients and improves symptoms, while verapamil shows variable effects on exercise capacity and hemodynamics.
Metoprolol may be preferred for LVOT gradient reduction in HCM; leaves open optimal therapy given limited mixed evidence.
Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease and is a prevalent cause of sudden cardiac death (SCD). This study aims to establish the benefits and therapeutic value metoprolol or verapamil offer to patients who suffer from symptoms caused by HCM, with regard to resolving left ventricular outflow tract obstruction (LVOTO), as well as improving a patient's quality of life and reducing symptoms. We conducted a systematic review to find clinical studies that described the use of metoprolol or verapamil in the management of HCM. Three databases were analyzed for studies, PubMed, Google Scholar, and ScienceDirect. We discovered 6,260 potentially eligible records across all the databases. According to our eligibility criteria, we included four studies in this review. Metoprolol showed median left ventricular outflow tract (LVOT) gradients of 25 mm Hg versus 72 mm Hg (P = 0.007) at rest, 28 mm Hg versus 62 mm Hg (P < 0.001) at peak exercise, and 45 mm Hg versus 115 mm Hg (P < 0.001) post-exercise. Verapamil also showed a statistically significant increase in exercise capacity. Both drugs have been shown to be safe to use with a good side effect profile; however, metoprolol was better tolerated in the patient population that was tested in the studies collected. In this study, metoprolol was effective in reducing LVOT and improving the quality of life in patients, while verapamil showed variable effects on both exercise capacity and baseline hemodynamics.
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Taha et al. (2023) conducted a systematic review in Hypertrophic Cardiomyopathy (n=159). Metoprolol or Verapamil vs. Placebo, Nadolol, or Diltiazem was evaluated on Median left ventricular outflow tract (LVOT) gradient at rest (mm Hg) (p=0.007). Metoprolol significantly reduced median resting LVOT gradients (25 vs 72 mm Hg) compared to placebo, while verapamil showed variable effects on exercise capacity and baseline hemodynamics.
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