The impact of disopyramide on exercise capacity among patients with obstructive hypertrophic cardiomyopathy: beyond left ventricular outflow tract gradient - Summary - MDSpire
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The impact of disopyramide on exercise capacity among patients with obstructive hypertrophic cardiomyopathy: beyond left ventricular outflow tract gradient
To examine the effects of disopyramide on exercise capacity and dynamic left ventricular gradient in patients with obstructive hypertrophic cardiomyopathy (oHCM), highlighting its significance in treatment options.
Key Findings:
Resting LVOT gradient decreased from 40 to 29 mmHg (P = 0.08), indicating a trend towards improved hemodynamics.
Peak exercise gradient decreased from 63 to 41 mmHg (P = 0.014), suggesting significant clinical relevance.
Significant reduction in resting heart rate (78 to 68 b.p.m.; P = 0.02) and peak heart rate (131 to 113 b.p.m.; P = 0.001), which may impact patient management.
Functional capacity decreased significantly (20 mL/kg/min to 17 mL/kg/min; P = 0.02), raising concerns about treatment effects.
Trends towards improved QoL (MLHFQ score reduction from 28.9 to 27; P = 0.19) and NYHA class improvement, warranting further investigation.
Interpretation:
Disopyramide effectively reduces LVOTO and may marginally improve QoL in oHCM patients, but it does not enhance exercise capacity as measured by pVO2, which has implications for treatment strategies.
Limitations:
Small sample size of 21 patients, which may limit generalizability.
Lack of control group for comparison, affecting the robustness of conclusions.
Short duration of follow-up (3 months), necessitating longer-term studies.
Conclusion:
Disopyramide improves symptoms and decreases LVOTO in oHCM patients but does not enhance exercise capacity or pVO2, underscoring the need for careful consideration of treatment options.
by Geza Halasz, Lorenzo Lupo Dei, Francesco Moroni, Michael P Ayers, Paolo Ciacci, Guido Giacalone, Raffaella Mistrulli, Marco Redivo, Santiago Orellana, Domenico Gabrielli, Massimo Piepoli, Federica Re
