Treatment of Hypertrophic Cardiomyopathy in Heart Failure (NYHA Class II–IV) Without Left Ventricular Outflow Tract Obstruction

This protocol addresses hypertrophic cardiomyopathy presenting with symptomatic heart failure at NYHA functional class II–IV, a left ventricular ejection fraction below 50%, and no left ventricular outflow tract obstruction. The absence of LVOTO defines this as non-obstructive HCM with a reduced or mildly reduced ejection fraction.

When hypertrophic cardiomyopathy is complicated by heart failure without outflow obstruction, management follows an evidence-based framework aligned with established heart failure guidelines. The lack of LVOTO directs treatment along a pathway distinct from obstructive disease, focusing on optimising cardiac function and relieving symptoms across NYHA classes II through IV.

Management centres on guideline-directed neurohormonal therapy — beta-blockade and agents targeting the renin-angiotensin-aldosterone system are core components — together with further agents and adjunctive measures detailed in the full protocol.