Evolving Story of Clinical Trials in Hypertrophic Cardiomyopathy
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See Article by Olivotto et al
Our greatest glory is not in never falling, but in rising every time we fall.
—Attributed to Confucius
Thousands of papers on hypertrophic cardiomyopathy have been published since Donald Teare’s landmark description of the disease in 1958, but in spite of considerable advances in its management, clinicians still struggle with the treatment of symptoms in people afflicted by the condition. Patients with hypertrophic cardiomyopathy often complain of exertional chest pain, dyspnea, and fatigue.1 The underlying mechanisms are complex and vary between patients; in some, heart failure symptoms are caused by diastolic dysfunction with preserved ejection fraction and in others by systolic left ventricular dysfunction or left ventricular outflow tract obstruction (with or without mitral insufficiency). Atrial fibrillation is frequent in both scenarios and often exacerbates symptoms.
When caused by dynamic left ventricular outflow tract obstruction, exertional symptoms can be managed effectively with drugs or interventions, such as surgical septal myectomy and alcohol septal ablation. However, treatment options in nonobstructive patients are usually much less successful and are often associated with side effects. In this issue of Circulation: Heart Failure, Olivotto et al2 report a multicenter, double-blind, phase 2 study of ranolazine—an inhibitor of the cardiac late sodium current (INaL)—in 80 adult patients with …