American Heart Association volunteer expert on HCM, James E. Udelson, M.D., is Chief, Division of Cardiology; Director, Nuclear Cardiology Laboratory; professor, Tufts University School of Medicine, Boston, Massachusetts.

Offering perspective on AHA Scientific Sessions 2020 Presentation P1732 
copyright American Heart Association 2020

"It's important to remember that there's other treatments, beta-blockers, calcium channel blockers, dysopyramide or Norpace, drugs which have been used for decades, really, for treating hypertrophic cardiomyopathy. And there's also very successful invasive procedures. Surgical myectomy, where a piece of the heart muscle is removed surgically, that's in the way of the outflow, or a cath lab technique called alcohol septal ablation, where a very controlled, small heart attack is made in the thick part of the heart to get it to shrink down a little bit. All of those have been around for a long time, and some of them, surgery for instance, almost are virtually hundred percent relieve symptoms dramatically. 

However, this is really the first time the drug has been put through the FDA regulatory process, under very carefully controlled conditions, with a trial like this, like explorer with a control group and blinded. The usual sort of rigorous things we look for in many drugs and so in theory, this drug should be available next year. Where would you use this in the treatment paradigm? You'd probably start with the drugs like beta blockers and possibly calcium channel blockers that have been around for a long time because some patients will respond to that and they've been around a long time, very inexpensive. But when you get to the point of thinking about dysopyramide or surgery, somewhere in there, this drug may slot in there and may be more effective than dysopyramide. Seemingly not as effective as surgery, but some patients may want to give this a try before moving on to surgery and if they have a really good response, well that's great, and maybe they will be able to avoid invasive procedures."