Future Role of New Negative Inotropic Agents in the Era of Established Surgical Myectomy for Symptomatic Obstructive Hypertrophic Cardiomyopathy

Indeed, initially, HCM was a disease for which management was based largely on pharmacotherapy (eg, betablockers; verapamil), as well as infrequent highrisk surgical procedures.4 However, predominantly nonpharmacologic innovations over the last 20 to 25 years have dramatically adjusted patient expectations for longevity and good quality of life, including reversibility of heart failure with surgical myectomy (and its selective alternative alcohol septal ablation).3,5,6 In the present commentary we discuss the effective treatment modalities currently available for HCMrelated heart failure due to left ventricular (LV) outflow obstruction, anticipating the emergence of new medications for symptomatic patients, and the role such therapies may have with respect particularly to timehonored surgical myectomy.