The recent updates to the national guidelines for managing hypertrophic cardiomyopathy (HCM) mark significant changes in treatment approaches and recommendations. The American College of Cardiology (ACC) and the American Heart Association (AHA) jointly published these updated guidelines in their respective journals.
One notable change is the endorsement of cardiac myosin inhibitors for certain cases of symptomatic obstructive HCM where first-line drug therapy, such as beta blockers or nondihydropyridine calcium channel blockers, does not provide sufficient relief. However, this recommendation is limited to adult patients and comes with the caution of monitoring for potential adverse effects on systolic function.
Another significant update is the encouragement of more intensive physical activity for HCM patients. The guidelines now emphasize the importance of a healthy lifestyle, including engaging in low-to-moderate intensity physical activities. Moreover, there is no longer a universal restriction on vigorous physical activity or competitive sports for HCM patients. Instead, decisions regarding participation in such activities should involve shared decision-making between patients and healthcare professionals.
The guidelines also provide new recommendations for younger patients. For instance, valsartan is now considered for slowing adverse cardiac remodeling in nonobstructive HCM patients under the age of 45 with specific genetic variants. Additionally, the criteria for considering implantable cardioverter defibrillators in HCM patients have been updated, removing the age criterion of at least 16 years old.
Furthermore, pediatric HCM patients are now recommended to undergo exercise stress testing for functional capacity assessment and prognostication, regardless of symptom status. This is particularly important as children may not readily express symptoms, and new risk calculators specific to their age group have been validated.
However, the guidelines also include precautions, such as a contraindication warning for mavacamten (Camzyos) during pregnancy due to potential teratogenic effects.
Overall, these updates reflect advancements in understanding and managing HCM, with a focus on personalized treatment approaches and shared decision-making between patients and healthcare providers. The collaboration between various medical societies underscores the multidisciplinary approach required for effective HCM management.
