Book Review: Hypertrophic Cardiomyopathy—A Practical Guide to Diagnosis and Management

I was delighted to be asked to review Hypertrophic Cardiomyopathy: A Practical Guide to Diagnosis and Management by Dr. Srilakshmi M. Adhyapak and Dr. V Rao Parachuri, as I have had a continuing interest in the diagnosis and management of hypertrophic cardiomyopathy (HCM) since my publication of one of the earliest reports on the use of beta adrenergic blockade in HCM.

The goal of this book was “to provide cardiac surgeons and cardiologists with a comprehensive perspective of HCM.” In this, it has certainly succeeded. The book is a compact publication, which—in 175 pages—provides updated and valuable information and references. In addition, the indexing makes it easy to find the appropriate sections in the book.

The importance of genetic transmission is well-known and appropriately discussed in the book. The reader’s understanding is clarified with particular reference to the clinical indications, and the role of genetic counselling is clearly explained. New areas like pre-pregnancy testing and targeted gene editing are discussed.

The surgical chapters and video explaining myectomy are excellent. The book is a must-read for any cardiologist and all surgeons performing myectomy. The importance of associated mitral valve abnormalities, their detailed description, and their role in outflow tract obstruction are spelled out clearly in different parts of the book. An entire chapter is devoted to mitral valve pathology in HCM and its implications for surgical repair. The late results of heart transplantation in HCM are the same as in ischemic and other cardiomyopathies, and the indications are clarified. The authors also point out that symptomatic patients with HCM, without obstruction, and with an ejection fraction greater than 50 percent should also be considered. They tend to be rejected because of conventional criteria. In addition to this information, there is a report of the surgical results from one of the HCM centers in India.

Sudden cardiac death (SCD) is one of the dreaded complications of HCM. Risk stratification of patients is well explained in the book using the HCM Risk—SCD calculator. Patients with HCM and prior cardiac arrest should undergo automatic implantable cardioverter defibrillator (AICD) insertion. AICD has no effect on exertional symptoms.

Not much is known about the effect of myectomy on patients with syncope. However, the book provides references on the beneficial effects of myectomy on syncopal episodes and defibrillator discharges. The importance of myectomy in patients at risk of SCD with exertional symptoms should be carefully considered. Management of various arrhythmias is discussed in detail.

The natural history of HCM in children is not well-known. Despite this, the differences in this age group are explained in the book. Again, the differences in adults between those with and without obstruction are not generally appreciated. It is important to realize that for patients with heart failure and obstruction there is a “cure” with myectomy.

Echocardiography is a basic tool in the diagnosis of HCM, and the tool that helps assess involvement in first degree relatives. In the book, different diagnosis techniques are described, along with new imaging modalities like speckle tracking and 3D echocardiography. The different patterns of ventricular hypertrophy, changes in the mitral valve apparatus, and indications for the use of transesophageal echocardiogram (TEE) are clarified.

Cardiac magnetic resonance Imaging (CMR) is a new method that has made a great difference in the diagnosis and management of HCM. Tissue characterization enables doctors to estimate the extent of myocardial fibrosis. This is an important predictor of prognosis. In addition, new drugs like mavacamten will hopefully change the prognosis of patients with HCM.

Overall, this book is a valuable contribution for those involved in the care of patients with HCM, and I strongly recommend it.

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