{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T01:45:39Z","timestamp":1790214339209,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>There is controversy about preferred methods to relieve obstruction in hypertrophic cardiomyopathy patients still symptomatic after \u03b2-blockade or verapamil.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      Of 737 patients prospectively registered at our institution, 299 (41%) required further therapy for obstruction for limiting symptoms, rest gradient 61\u00b145, provoked gradient 115\u00b149 mm\u2009Hg, and followed up for 4.8 years. Disopyramide was added in 221 (74%) patients and pharmacological control of symptoms was achieved in 141 (64%) patients. Overall, 138 (46%) patients had surgical relief of obstruction (91% myectomy) and 6 (2%) alcohol septal ablation. At follow-up, resting gradients in the 299 patients had decreased from 61\u00b144 to 10\u00b125 mm\u2009Hg (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001); New York Heart Association class decreased from 2.7\u00b10.7 to 1.8\u00b10.5 (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001). Kaplan\u2013Meier survival at 10 years in the 299 advanced-care patients was 88% and did not differ from nonobstructed patients (\n                      <jats:italic>P<\/jats:italic>\n                      =0.28). Only 1 patient had sudden death, a low annual rate of 0.06%\/y. Kaplan\u2013Meier survival at 10 years in the advanced-care patients did not differ from that expected in a matched cohort of the US population (\n                      <jats:italic>P<\/jats:italic>\n                      =0.90).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>Patients with obstruction and symptoms resistant to initial pharmacological therapy with \u03b2-blockade or verapamil may realize meaningful symptom relief and low mortality through stepped management, adding disopyramide in appropriately selected patients, and when needed, by surgical myectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.112.000122","type":"journal-article","created":{"date-parts":[[2013,5,24]],"date-time":"2013-05-24T01:14:47Z","timestamp":1369358087000},"page":"694-702","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":163,"title":["Treatment of Obstructive Hypertrophic Cardiomyopathy Symptoms and Gradient Resistant to First-Line Therapy With \u03b2-Blockade or Verapamil"],"prefix":"10.1161","volume":"6","author":[{"given":"Mark V.","family":"Sherrid","sequence":"first","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Program, St. Luke\u2019s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.V.S., A.S., G.W., B.K., D.M., C.L.A., P.H., S.K.B., D.G.S.); and Heart and Vascular Institute, Valley Health Care System, Ridgewood, NJ (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneesha","family":"Shetty","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Program, St. Luke\u2019s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.V.S., A.S., G.W., B.K., D.M., C.L.A., P.H., S.K.B., D.G.S.); and Heart and Vascular Institute, Valley Health Care System, Ridgewood, NJ (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenda","family":"Winson","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Program, St. Luke\u2019s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.V.S., A.S., G.W., B.K., D.M., C.L.A., P.H., S.K.B., D.G.S.); and Heart and Vascular Institute, Valley Health Care System, Ridgewood, NJ (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bette","family":"Kim","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Program, St. Luke\u2019s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.V.S., A.S., G.W., B.K., D.M., C.L.A., P.H., S.K.B., D.G.S.); and Heart and Vascular Institute, Valley Health Care System, Ridgewood, NJ (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Musat","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Program, St. Luke\u2019s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.V.S., A.S., G.W., B.K., D.M., C.L.A., P.H., S.K.B., D.G.S.); and Heart and Vascular Institute, Valley Health Care System, Ridgewood, NJ (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos L.","family":"Alviar","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Program, St. Luke\u2019s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.V.S., A.S., G.W., B.K., D.M., C.L.A., P.H., S.K.B., D.G.S.); and Heart and Vascular Institute, Valley Health Care System, Ridgewood, NJ (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Homel","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Program, St. Luke\u2019s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.V.S., A.S., G.W., B.K., D.M., C.L.A., P.H., S.K.B., D.G.S.); and Heart and Vascular Institute, Valley Health Care System, Ridgewood, NJ (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandhya K.","family":"Balaram","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Program, St. Luke\u2019s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.V.S., A.S., G.W., B.K., D.M., C.L.A., P.H., S.K.B., D.G.S.); and Heart and Vascular Institute, Valley Health Care System, Ridgewood, NJ (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G.","family":"Swistel","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Program, St. Luke\u2019s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.V.S., A.S., G.W., B.K., D.M., C.L.A., P.H., S.K.B., D.G.S.); and Heart and Vascular Institute, Valley Health Care System, Ridgewood, NJ (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.106.644682"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021332"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318223e230"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(03)00941-0"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.7.1680"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2005.068577"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.01.012"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.02.090"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.111.076257"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.07.048"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.08.040"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2013.02.007"},{"key":"e_1_3_2_14_2","first-page":"A61. 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