Discontinuation of afterload-reducing drugs decreases left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy.

Autor:	Derda AA; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.; Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany., Abelmann M; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.; Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany., Sonnenschein K; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.; Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany., Sieweke JT; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany., Bavendiek U; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany., Bauersachs J; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany., Thum T; Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany., Berliner D; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2024 Jul 16; Vol. 11, pp. 1403422. Date of Electronic Publication: 2024 Jul 16 (Print Publication: 2024).
DOI:	10.3389/fcvm.2024.1403422
Abstrakt:	Background: Hypertrophic cardiomyopathy (HCM), the most common genetic heart disease, is classified into hypertrophic non-obstructive and hypertrophic obstructive cardiomyopathy (HOCM). Patients with HOCM and coexisting heart failure or arterial hypertension are often prescribed afterload-reducing drugs. Although recommended in current guidelines, data on the direct effect of discontinuing afterload-reducing medication are scarce. This study aims to demonstrate the benefit of discontinuing afterload-reducing medication in HOCM patients. Methods: This monocentric retrospective analysis included 24 patients with HOCM with afterload-reducing medication, including angiotensin-converting enzyme inhibitors, angiotensin-1 receptor blocker and dihydropyridine-calcium channel blocker, at their first outpatient visit. Effects of discontinuing this medication on LVOTO were examined compared to patients with persistent use despite medical advice. Results: 16 patients discontinued their afterload-reducing drugs, resulting in a significant decrease in median LVOT gradient from 86.5 [60.5-109.3] mmHg to 61.5 [28.3-97.50] mmHg ( p  = 0.0004). In 6 patients, beta-blocker therapy was initiated simultaneously, or the dose was increased. Regardless, LVOT gradient reduction was also significant in the remaining 10 patients ( p  = 0.001). The gradient was not changed significantly in the 8 patients continuing their afterload-reducing medication. Conclusions: Discontinuation of afterload-reducing drugs significantly decreases LVOTO. Our study underscores the significance of abstaining from afterload-reducing drugs in HOCM patients, particularly in patients with concomitant hypertension or heart failure. According to recently published European guidelines, HOCM patients should preferably be treated with beta-blockers or non-dihydropyridine-calcium channel blockers. Competing Interests: AD received honoraria for lectures by AstraZeneca, BMS, Boehringer Ingelheim and Bayer not related to this article. KS received presentation honoraria and travel grants from medi, Novartis, BMS, Chiesi and Amicus. JB received honoraria for lectures/consulting from Novartis, Vifor, Bayer, Pfizer, Boehringer Ingelheim, AstraZeneca, Cardior, CVRx, BMS, Amgen, Corvia, Norgine, Edwards, Roche not related to this article; and research support for the department from Zoll, CVRx, Abiomed, Norgine, Roche, not related to this article. DB received honoraria for lectures/consulting from Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Edwards Lifesciences, Pfizer. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2024 Derda, Abelmann, Sonnenschein, Sieweke, Bavendiek, Bauersachs, Thum and Berliner.)
Databáze:	MEDLINE
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