30
Treatment
8.2. Management of Patients With Nonobstructive HCM With
Preserved EF
COR LOE
Recommendations
1 C-LD
1. In patients with nonobstructive HCM with preserved
EF and symptoms of exertional angina or dyspnea, beta
blockers or nondihydropyridine calcium channel blockers are
recommended.
2a C-EO
2. In patients with nonobstructive HCM with preserved
EF, it is reasonable to add oral diuretics when exertional
dyspnea persists despite the use of beta blockers or
nondihydropyridine calcium channel blockers.
2b C-LD
3. In patients with nonobstructive HCM with preserved EF, the
usefulness of angiotensin-converting enzyme inhibitors and
angiotensin receptor blockers in the treatment of symptoms
(angina and dyspnea) is not well established.
2b C-LD
4. In highly selected patients with apical HCM with severe
dyspnea or angina (NYHA class III or class IV) despite
maximal medical therapy, and with preserved EF and small
LV cavity size (LV end-diastolic volume <50 mL/m
2
and LV
stroke volume <30 mL/m
2
), apical myectomy by experienced
surgeons at comprehensive centers may be considered to
reduce symptoms.
2b C-EO
5. In asymptomatic patients with nonobstructive HCM, the
benefit of beta blockers or calcium channel blockers is not
well established.
2b B-R
6. For younger (eg, ≤45 years of age) patients with
nonobstructive HCM due to a pathogenic or likely
pathogenic cardiac sarcomere genetic variant, and a mild
phenotype,* valsartan may be beneficial to slow adverse
cardiac remodeling.
* Mild phenotype indicates NYHA class I or II, maximal le ventricular wall thickness 13 to
25 mm, no secondary prevention ICDs, no history of appropriate ICD shocks, and no atrial
fibrillation.
