GDV vs SDV in Patients With Hypertrophic Cardiomyopathy on Myosin Inhibitors

Background: Hypertrophic cardiomyopathy (HCM) is a common autosomal dominant disease. The disorder is caused by myofibril disarray, causing multiple abnormalities, including left ventricular outflow tract (LVOT) obstruction, which is an important part of diagnosis and treatment. A significant gradient is defined as a resting or provoked gradient of ≥30 mm Hg. The self-directed Valsalva (SDV) maneuver is a common method of provoking a gradient, but there is variation in implementing this maneuver. An alternative is a goal-directed Valsalva (GDV), which is accomplished by the patient blowing into a 10 mL syringe connected to a manometer by rubber tubing, maintaining a pressure of 40 mm Hg for 10 seconds. Objective: To compare SDV versus GDV and the clinical implications in patients with obstructive HCM receiving mavacamten, a cardiac myosin inhibitor. Design: Single-center, prospective cohort study. Participants: 69 patients receiving mavacamten for HCM according to the risk evaluat more...