What is Hypertrophic Cardiomyopathy?

Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle (myocardium) becomes abnormally thick (hypertrophied). HCM occurs if heart muscle cells enlarge and cause the walls of the ventricles (usually the left ventricle) to thicken.

The ventricle size often remains normal, but the thickening may block blood flow out of the ventricle. If this happens, the condition is called Obstructive hypertrophic cardiomyopathy (HOCN). Sometimes the septum, the wall that divides the left and right sides of the heart, thickens and bulges into the left ventricle.

This can block blood flow out of the left ventricle. Then the ventricle must work hard to pump blood. Symptoms can include chest pain, dizziness, shortness of breath, or fainting. HCM also can affect the heart's mitral valve, causing blood to leak backward through the valve. Sometimes, the thickened heart muscle doesn't block blood flow out of the left ventricle. This is referred to as Non-obstructive hypertrophic cardiomyopathy (HNCM).

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The entire ventricle may thicken, or the thickening may happen only at the bottom of the heart. The right ventricle also may be affected. In both obstructive and non-obstructive HCM, the thickened muscle makes the inside of the left ventricle smaller, so it holds less blood. The walls of the ventricle may stiffen, and as a result, the ventricle is less able to relax and fill with blood.

HCM can affect people of any age. It affects men and women equally but sometimes the prevalence of HCM is evaluated more in men as compared to women. It is a common cause of sudden cardiac arrest in young people, including young athletes.

Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease and an important cause of sudden death and heart failure symptoms. The current prevalence for HCM is based on echocardiographic population studies in which a substantial proportion of affected subjects have not come to clinical recognition.

In addition, most patients with HCM never develop (or recognize) cardiovascular symptoms, experience an adverse disease-related event or are identified with another clinical marker (e.g., abnormal electrocardiogram and family history) which could lead to clinical Recognition.

The goal of Hypertrophic Cardiomyopathy treatment is to relieve symptoms and prevent sudden cardiac death in people at high risk. Specific treatment varies depending on the severity of symptoms. There are no large randomized clinical trials available to evaluate different drug therapy in symptomatic patients with HCM.

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Since most symptoms from H0CM are related to left ventricular outflow tract obstruction, which occurs during systole, medical therapy is aimed at lowering the heart rate to allow better diastolic filling and using negative inotropic agents to decrease the force of contractility. The pharmacotherapy of symptomatic HNCM consists of the treatment of heart failure with a normal ejection fraction (HFNEF).

Non-dihydropyridine calcium channel blockers, such as verapamil are commonly used. These drugs slow the heart rate and decrease the inotropic force of left ventricular contraction, relieving the symptoms of HOCM. Beta-blockers act similarly in mechanism as the above in HOCM patients. Disopyramide is the historical treatment for HOCM. This drug has significant negative inotropic effects, but is considered an antiarrhythmic drug.

There is no specific treatment or approved drug for the treatment of HCM. A septal myectomy is an open-heart procedure in which the surgeon removes part of the thickened, overgrown septum between the ventricles. Removing part of this overgrown muscle improves blood flow and reduces mitral regurgitation. A septal myectomy may be recommended if medications don't relieve the symptoms. Most people who have a myectomy have no further symptoms. Septal myectomy is available only in medical centers that specialize in the treatment of hypertrophic cardiomyopathy.

Septal ablation is another treatment, in which a small portion of the thickened heart muscle is destroyed by injecting alcohol through a long, thin tube (catheter) into the artery supplying blood to that area. This procedure may improve the symptoms. To redress the current issues, the companies are currently working toward this indication to meet the needs of the current market.

Pipeline drugs in clinical development are designed to address this unmet need in the HCM treatment. The other factors that shall further expedite the growth of HCM market include increasing morbidity rate of HCM and increasing awareness about available treatments during the forecast period (2021–2030). A better understanding of disease pathogenesis will also contribute to the development of novel therapeutics for Hypertrophic Cardiomyopathy.

Extensive research and development activities of pharmaceutical companies for developing the therapies for HCM will significantly impact the market. Expected launch of Mavacamten (Bristol Myers Squibb) CK-274 (Cytokinetics), and LCZ-696 (Novartis) shall fuel the growth of the market during the forecast period, i.e., 2021–2030.

The dynamics of HCM market are anticipated to change in the coming years owing to the improvement in the diagnosis methodologies, raising awareness of the disease, incremental healthcare spending across the world. Key players in the therapeutic market of HCM at the global level are MyoKardia (now acquired by Bristol Myers Squibb), Cytokinetics, Novartis, Celltrion etc. Expected launch of emerging therapy, such as Mavacamten, CK-274, CT-G20 will significantly impact the HCM market during the forecast period (2021– 2030).

Other therapies that are used for treatment of HOCM include- Defibrillator therapy, Dual-chamber pacing, Biventricular pacing and Heart Transplantation. Out of these, Defibrillator therapy is the only non-surgical therapy proven to reduce mortality in HCM patients when used in patients with appropriate risk. It is widely accepted that internal cardioverter defibrillator (ICD) placement is warranted for secondary prevention in patients who have survived ventricular fibrillation or ventricular tachycardia arrest. However, the question of which HCM patients warrant a primary prevention using ICD remains an area of intense study.

There are many therapies which are being used for the management of the HCM, but they often are ineffective and causes severe adverse effects. These therapies give only symptomatic treatment. Due to its relative rarity and the complexity of its clinical symptoms, patients with HCM require continuous monitoring. Symptomatic treatment of patients with HNCM corresponds to the specific treatment of heart failure. So, there is a significant need for drug therapies that can treat the root cause of HCM.

Original Source:- Hypertrophic Cardiomyopathy Market Research