CORRESPONDENCE: LETTERS TO THE EDITOR
Treating Hypertrophic Cardiomyopathy: Two Views
Lisa Salberg*
* Hypertrophic Cardiomyopathy Association (HCMA), P.O. Box 306, Hibernia, NJ 07842 (Email: support{at}4hcm.org).
I am writing in response to the published views in JACC regarding treatment of hypertrophic cardiomyopathy (1). I am the president of the Hypertrophic Cardiomyopathy Association (HCMA), a nonprofit organization providing information, advocacy, and support to patients with this often misunderstood genetic cardiac disease, and to their families and the medical community. As such, I have the responsibility to speak on behalf of the over 2,500 HCM families represented by the HCMA.
The case for surgical septal myectomy presented by Maron et al. defends and promotes a time-honored treatment strategy with a balanced, well-referenced discussion, which is consistent with the recent 2003 American College of Cardiology/European Society of Cardiology (ACC/ESC) expert consensus panel on the management of hypertrophic cardiomyopathy (2). That document promotes surgical myectomy as the primary "gold standard" treatment for patients with severe heart failure and outflow obstruction refractory to medical treatment.
The "counterpoint" authored by Drs. Otto Hess and Ulrich Sigwart (3) was, in contrast, brief and incomplete. Specifically, the researchers chose to omit the surgical option from their HCM treatment algorithm. This arbitrary exclusion of surgical myectomy is contraproductive to providing clinicians and HCM patients with all the necessary information to understand the treatment options in this complex disease. The researchers have, therefore, omitted a treatment strategy from their Figure 1 (pg. 2055) (i.e., septal myectomy), which has, in fact, provided symptomatic benefits and enhanced longevity to thousands of HCM patients worldwide for over 45 years.
It is the role of the HCMA to provide information to our patients and families, which is accurate and consistent with the entire body of literature on HCM. Patients have a right to know all about treatment options available; therefore, it is a disservice to the patient population for Drs. Hess and Sigwart to arbitrarily withdraw the "gold standard" treatment of surgical septal myectomy from severely symptomatic obstructive HCM. These comments are presented in the best interests of the HCM patient population.
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1. Maron BJ, Dearani JA, Ommen SR, et al. The case for surgery in obstructive hypertrophic cardiomyopathy J Am Coll Cardiol 2004;44:2044-2053.[Abstract/Free Full Text]
2. Maron BJ, McKenna WJ, Danielson GK, et al. American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines J Am Coll Cardiol 2003;42:1687-1713.[Free Full Text]
3. Hess OM, Sigwart U. New treatment strategies for hypertrophic cardiomyopathyalcohol ablation of the septum: the new gold standard?. J Am Coll Cardiol 2004;44:2054-2055.[Abstract/Free Full Text]
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