Management of hypertrophic cardiomyopathy in Latin America: HCM-SIAC survey

Cristhian E. Scatularo, Departamento de Cardiología, Sanatorio de la Trinidad de Palermo, Buenos Aires, Argentina
Josefina B. Parodi, Departamento de Cardiología, Sanatorio Anchorena de San Martín, Buenos Aires, Argentina
Carlos Guamán-Valdivieso, Departamento de Cardiología, Hospital Metropolitano, Quito, Ecuador
Antonio Jordan-Ríos, Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Jorge P. Juárez-Lloclla, Departamento de Cardiología, Hospital de la Amistad, Piura, Perú
Ana C. Alba, Peter Munk Cardiac Centre, University Health Network, Toronto, Canadá
Eugenio Cingolani, Centro Médico Cedars-Sinai, Universidad de California, Los Ángeles, California, EE.UU.
María I. Sosa-Liprandi, Unidad de Insuficiencia Cardiaca, Sanatorio Güemes, Buenos Aires, Argentina
Vladimir E. Ullauri-Solórzano, Departamento de Cardiología, Hospital Metropolitano, Quito, Ecuador
Ricardo López-Santi, Departamento de Cardiología, Hospital Italiano de La Plata, La Plata, Argentina
Ana Múnera-Echeverri, Departamento de Cardiología, Clínica Rosario Tesoro-Cardioestudio, Medellín, Colombia
Adrián Baranchuk, Facultad de Medicina, Universidad Abierta Interamericana, Buenos Aires, Argentina

Background: Hypertrophic cardiomyopathy (HCM) is a myocardial disease characterized by ventricular hypertrophy unexplained by hemodynamic overload. Its clinical management is challenging, particularly in Latin America, due to limited availability of advanced diagnostic and therapeutic resources. Objective: To conduct a survey to describe the current approach to HCM in the region. Method: A descriptive study was conducted using a self-administered online questionnaire directed at Latin American cardiologists. The survey explored diagnostic and therapeutic strategies employed in the daily clinical management of patients with HCM. Results: A total of 406 cardiologists participated (median age 44 years; 66.7% male; 74.4% with experience in HCM). The most frequent symptoms were dyspnea (75.5%), palpitations (69.5%), and exertional angina (51%). Echocardiography and electrocardiography were essential for detecting signs suggestive of HCM. Other commonly performed studies included Holter monitoring (98%), cardiac magnetic resonance imaging (92.5%), and exercise testing (77.4%). Limited accessibility was higher for cardiopulmonary exercise testing (11.3% without access) and genetic studies (10.6% without access). Beta-blockers were the most frequently used medications (> 90% of physicians), and implantable cardioverter-defibrillators were the most indicated invasive procedure (> 70% of physicians), while access to other advanced therapies was more restricted. Conclusions: HCM management in Latin America is heterogeneous and limited by resource availability. These findings highlight the need to strength tools and education, expand access to advanced diagnostic and therapeutic tools, and develop national registries to adapt international guidelines to the regional context.

Keywords: Hypertrophic cardiomyopathy. Heart failure. Myosin inhibitors. Beta-blockers. Implantable cardioverter-defibrillator. Latin America.