Myosin Inhibitors for Hypertrophic Obstructive Cardiomyopathy (HOCM): Is HOCM passing another Crossroad?

The evolution of therapeutic options in the treatment of Hypertrophic Obstructive Cardiomyopathy (HOCM) was characterized by several milestones since it´s first description in 1962 ( 1 GOODWIN J.F. HOLLMAN A. CLELAND W.P. TEARE D. Obstructive cardiomyopathy simulating aortic stenosis. Br Heart J. 1960 Jun; 22 (PMID: 13851098; PMCID: PMC1017672): 403-414https://doi.org/10.1136/hrt.22.3.403 Crossref PubMed Scopus (129) Google Scholar ). Today various forms of therapies are available to modify the natural course of this complex disease (Table 1, Figure 1). All those different therapeutic options (medical-, surgical- and interventional treatment) were important cornerstones in the treatment of patients suffering from HOCM throughout the history. It is of great importance to consider all available therapeutic strategies in the management of HCM. Table 1Cornerstones of HOCM management. Risk reduction Risk of sudden cardiac death ICD-Implantation Stroke prevention Oral anticoagulants (atrial fibrillation, apical aneurysm with thrombus) Symptom control LVOT obstruction Negativ inotropes •Beta blockers •Calcium channel blockers •Disopyramide •Myosin Inhibitors Surgical myectomyAlcohol septal ablationEndocardial RF-ablation of septal hypertrophy ( 3 Maron B.J. Spirito P. Shen W.K. Haas T.S. Formisano F. Link M.S. Epstein A.E. Almquist A.K. Daubert J.P. Lawrenz T. Boriani G. Estes 3rd, N.A. Favale S. Piccininno M. Winters S.L. Santini M. Betocchi S. Arribas F. Sherrid M.V. Buja G. Semsarian C. Bruzzi P. Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA. 2007 Jul 25; 298 (Erratum in: JAMA. 2007 Oct 3;298(13):1516. PMID: 17652294): 405-412https://doi.org/10.1001/jama.298.4.405 Crossref PubMed Scopus (659) Google Scholar ) Atrial fibrillation Rate control: •Beta blockers •Calcium channel blockers Rhythm control: •Amiodarone •Sotalol •Catheter ablation Heart failure Optimal medical therapyHeart transplantation Abbreviations: ICD = Implantable Cardioverter-Defibrillator. LVOT = Left Ventricular Outflow Tract. Open table in a new tab Abbreviations: ICD = Implantable Cardioverter-Defibrillator. LVOT = Left Ventricular Outflow Tract.