Treatment of Hypertrophic Cardiomyopathy with Symptomatic Left Ventricular Outflow Tract Obstruction (LVOTO) — Resting or Provoked Gradient ≥50 mmHg

This protocol covers patients with hypertrophic cardiomyopathy (HCM) who experience symptoms attributable to left ventricular outflow tract obstruction, confirmed by a peak Doppler LVOT gradient of ≥50 mmHg at rest or on provocation.

Clinical Scenario

Symptoms are directly attributed to LVOTO. A resting or provoked peak instantaneous Doppler LV outflow tract gradient of ≥50 mmHg is present — the established threshold at which active treatment is considered.

Treatment Goal

The primary clinical objective in this setting is improvement of symptoms.

First-Line Approach

A specific class of beta-blocker, selected for its haemodynamic profile, forms the cornerstone of first-line pharmacotherapy — the full titration protocol and escalation pathway are in the complete regimen.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehad194

Non-vasodilating beta-blockers, titrated to maximum tolerated dose, are recommended as first-line therapy to improve symptoms in patients with resting or provoked LVOTO.
By convention, LVOTO is defined as a peak instantaneous Doppler LV outflow tract gradient of ≥30 mmHg, but the threshold for invasive treatment is usually considered to be ≥50 mmHg.
By consensus, patients with symptomatic LVOTO have been treated initially with non-vasodilating beta-blockers titrated to the maximum tolerated dose, but there are very few studies comparing individual beta-blockers.

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