Treatment options for hypertrophic obstructive cardiomyopathy in the era of myosin inhibitors
- 1Mid and South Essex NHS Foundation Trust
- 2Anglia Ruskin University School of Medicine and Medical Technical Research Centre
Abstract
Hypertrophic obstructive cardiomyopathy (HOCM) is characterised by left ventricular outflow tract obstruction (LVOTO) caused by septal hypertrophy and its interaction with the mitral valve and systolic anterior motion. Symptoms include dyspnoea, angina, palpitations, syncope, fatigue and sudden cardiac death. This review provides a comprehensive overview and breakdown of current available treatment options, including traditional medical therapies and surgical septal reduction therapies in the era of new emerging pharmacologic options, including myosin inhibitors. Traditional pharmacotherapy includes non-vasodilating beta blockers, calcium-channel blockers and disopyramide. For persistent symptoms, surgical myectomy and alcohol septal ablation remain important septal reduction therapies, with treatment choice depending on anatomy, procedural risk and site-specific expertise. Myosin inhibitors, including mavacamten and aficamten, offer a targeted approach to addressing the hypercontractility characteristic of hypertrophic obstructive cardiomyopathy, by directly modulating sarcomeric function. These agents may move earlier in the treatment pathway for selected patients with HOCM, although longer-term data, access, monitoring burden and cost-effectiveness remain important considerations.
Related
- Cardiac Myosin Inhibitors in Adults with Symptomatic Non-Obstructive Hypertrophic Cardiomyopathy: A Systematic Review and Meta-analysis of Randomized Controlled Trials
- Managing a mavacamten non-responder in obstructive hypertrophic cardiomyopathy: A case report
- Percutaneous endomyocardial ablation as a septal reduction strategy in symptomatic obstructive hypertrophic cardiomyopathy: A 20-year single-center observational experience.
- Hypertrophic obstructive cardiomyopathy complicated by severe midventricular obstruction treated with percutaneous transluminal septal myocardial ablation using simultaneous contrast imaging with left ventriculography and coronary angiography: a case report
- GLP-1 Receptor Agonist Use and Long-Term Outcomes in Hypertrophic Cardiomyopathy With Obstructive Sleep Apnea
BibTeX
@article{nwuba2026treatment,
title = {{Treatment options for hypertrophic obstructive cardiomyopathy in the era of myosin inhibitors}},
author = {Chukwunenyem Nwuba and Jason N. Dungu},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1814860},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1814860/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Treatment options for hypertrophic obstructive cardiomyopathy in the era of myosin inhibitors
AU - Chukwunenyem Nwuba
AU - Jason N. Dungu
PY - 2026
DA - 2026/10/27
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1814860
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1814860/full
AB - Hypertrophic obstructive cardiomyopathy (HOCM) is characterised by left ventricular outflow tract obstruction (LVOTO) caused by septal hypertrophy and its interaction with the mitral valve and systolic anterior motion. Symptoms include dyspnoea, angina, palpitations, syncope, fatigue and sudden cardiac death. This review provides a comprehensive overview and breakdown of current available treatment options, including traditional medical therapies and surgical septal reduction therapies in the era of new emerging pharmacologic options, including myosin inhibitors. Traditional pharmacotherapy includes non-vasodilating beta blockers, calcium-channel blockers and disopyramide. For persistent symptoms, surgical myectomy and alcohol septal ablation remain important septal reduction therapies, with treatment choice depending on anatomy, procedural risk and site-specific expertise. Myosin inhibitors, including mavacamten and aficamten, offer a targeted approach to addressing the hypercontractility characteristic of hypertrophic obstructive cardiomyopathy, by directly modulating sarcomeric function. These agents may move earlier in the treatment pathway for selected patients with HOCM, although longer-term data, access, monitoring burden and cost-effectiveness remain important considerations.
SN - 2297-055X
ER -