Hypertrophic Cardiomyopathy in Congestive Heart Failure (NYHA Class II–IV) with Reduced Ejection Fraction and No Left Ventricular Outflow Obstruction

This protocol applies to patients with hypertrophic cardiomyopathy who present with symptomatic congestive heart failure at NYHA functional class II through IV, a left ventricular ejection fraction below 50%, and no left ventricular outflow tract obstruction.

Clinical scenario: Hypertrophic cardiomyopathy without outflow obstruction, accompanied by congestive heart failure (NYHA class II–IV) and a reduced left ventricular ejection fraction (<50%).

In this subgroup, management follows guidance developed specifically for heart failure without outflow obstruction. The degree of functional impairment and the extent of ventricular dysfunction together shape the treatment approach.

Treatment direction: When the condition progresses despite medical management, advanced procedural or surgical options may come into consideration. The complete structured protocol — including selection criteria and sequencing — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

Management of heart failure in patients without LVOTO should follow the recommendations of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, summarized in Section 6.10.2.

Patients with progressive LV systolic or diastolic dysfunction refractory to medical therapy may be candidates for cardiac transplantation.

DOI: 10.1093/eurheartj/ehad194

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