Symptomatic Nonobstructive Hypertrophic Cardiomyopathy Remains Difficult to Treat

Patients with nonobstructive hypertrophic cardiomyopathy (HCM) commonly experience heart failure, which is often resistant to beta-blockers and calcium channel blockers. Perhexiline maleate inhibits fatty acid beta-oxidation and improves symptoms in these patients, but its toxicity limits long-term use. Another potential agent, not FDA-approved, is trimetazidine dihydrochloride, which has a better safety profile.

In a single-center, noncommercial study, 51 patients with nonobstructive HCM and heart failure were randomized to trimetazidine or placebo (NCT01696370). At 3 months, improvement in peak oxygen production (VO₂), 6-minute walk, and quality of life was no greater with trimetazidine than with placebo. In fact, trimetazidine was associa…