Bottom line
The strongest guideline recommendations for hypertrophic cardiomyopathy (Class I and IIa). Dosing is left to the guideline.
- Class I · LOE B-RAHA/ACC 2024
For patients with obstructive HCM who have persistent symptoms attributable to LVOTO despite beta blockers or nondihydropyridine calcium channel blockers, adding a myosin inhibitor (adult patients only), or disopyramide (in combination with an atrioventricular nodal blocking agent), or SRT performed at experienced centers, is recommended.
- Class I · LOE B-RAHA/ACC 2024
For patients with HCM, mild- to moderate-intensity recreational exercise is beneficial to improve cardiorespiratory fitness, physical functioning, and quality of life, and for overall health in keeping with physical activity guidelines for the general population.
- Class I · LOE BESC 2023
SRT to improve symptoms is recommended in patients with a resting or maximum provoked LVOT gradient of ≥50 mmHg who are in NYHA/Ross functional class III–IV, despite maximum tolerated medical therapy.
- Class I · LOE BESC 2023
Implantation of an ICD is recommended in patients who have survived a cardiac arrest due to VT or VF, or who have spontaneous sustained VT with haemodynamic compromise.
Overview
Unverified · drafted by AI from the sources cited below
Definition
Hypertrophic cardiomyopathy is a cardiac muscle disease characterized by left and/or right ventricular hypertrophy, frequent asymmetrical involvement of the heart septum, and normal or reduced left ventricular volume.1 Risk factors for the condition include hypertension, aortic stenosis, and gene mutation.1
Diagnosis and risk stratification
Hypertrophic cardiomyopathy carries a substantial risk of major adverse cardiovascular events, yet current tools do not fully exploit quantitative myocardial texture from routine echocardiography.1 A study developed a deep survival model integrating transthoracic echocardiographic texture radiomics with clinical and conventional echocardiographic variables, showing that age, RadScore, left atrial diameter, and maximal wall thickness were leading contributors.1
Where experts stand
Earlier trials experts reacted to
Expert labels are toward each trial's result, from named public quotes.
Treatment landscape
How AHA/ACC 2024 and ESC 2023 grade each treatment for hypertrophic cardiomyopathy. Each chip is that guideline's strongest recommendation; open it for the exact wording and who it applies to.
Septal reduction therapy
AHA/ACC 2024Class I · B-RESC 2023Class I · BWhat each guideline says →Hide wording
AHA/ACC 2024 · Class I · LOE B-R
For patients with obstructive HCM who have persistent symptoms attributable to LVOTO despite beta blockers or nondihydropyridine calcium channel blockers, adding a myosin inhibitor (adult patients only), or disopyramide (in combination with an atrioventricular nodal blocking agent), or SRT performed at experienced centers, is recommended.
ESC 2023 · Class I · LOE B
Landmark trials
Primary results of 4 trials behind the evidence on hypertrophic cardiomyopathy, as each trial’s own publication reports them.
aficamten vs metoprolol · 175 patients · N Engl J Med 2025
Primary outcome: the change in peak oxygen uptake at week 24
“least-squares mean between-group difference, 2.3 ml per kilogram per minute; 95% CI, 1.5 to 3.1; P<0.001”
aficamten vs placebo · 282 patients · N Engl J Med 2024
Primary outcome: the change from baseline to week 24 in the peak oxygen uptake as assessed by cardiopulmonary exercise testing
“least-squares mean between-group difference, 1.7 ml per kilogram per minute; 95% CI, 1.0 to 2.4; P<0.001”
mavacamten vs placebo · 112 patients · J Am Coll Cardiol 2022
Primary outcome: the composite of the proportion of patients proceeding with SRT or who remained guideline-eligible after 16 weeks' treatment
“difference (58.9%; 95% CI: 44.0%-73.9%; P < 0.001)”
Guideline recommendations
Class of recommendation is how strongly the society advises the action (I is strongest, III is not recommended). Level of evidence is the kind of studies behind it (A is randomized trials, C is expert opinion or limited data).
120 recommendations on hypertrophic cardiomyopathy from 2 guidelines, by strength.
- ESC 202339
Class IClass IIa
Key papers
2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy
Journal of the American College of Cardiology — Ommen S
387 citations · 2024 · among the most cited on Hypertrophic cardiomyopathy
Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): health status analysis of a randomised, double-blind, placebo-controlled, phase 3 trial
The Lancet — Spertus J
223 citations · 2021 · among the most cited on Hypertrophic cardiomyopathy
Effect of Mavacamten on Echocardiographic Features in Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy
Journal of the American College of Cardiology — Hegde S
198 citations · 2021 · among the most cited on Hypertrophic cardiomyopathy
New research on Hypertrophic cardiomyopathy
How this page is built
A clinical question appears here only when its condition matches this topic, an outcome and a comparator were extracted from the studies, at least two studies and a patient count are on file, and the certainty is low or higher.
Supports benefit, no benefit shown, and mixed describe the direction of the measured effect. No benefit shown means the evidence does not support a benefit. It is not a finding of harm. Too little evidence means the question did not clear that bar.
Study count, RCT count, and patient count are separate. The patient total adds only studies that are linked into a study family and whose sample size is not flagged as implausible. A reversal is listed only when at least one randomized trial sits on each side of the change.
The overview is drafted from the guideline recommendations, trials, papers, and questions on this page, and every sentence has to cite one of them. It stays unverified until an NPI-verified clinician or a Synapse admin approves it. Approving records that person's name.
