In the Thick of It

Patient advocates Hannah and Bethany Keime from HeartCharged sit down with Dr. John Fritzlen to discuss the long-term journey of living with hypertrophic cardiomyopathy (HCM). The conversation covers the progressive nature of the condition, including the onset of heart failure symptoms, atrial fibrillation, and myocardial remodeling over decades, as well as how advanced diagnostics like cardiopulm...

Dr. Florian Rader joins Dr. Louise Bjerregaard to discuss a groundbreaking randomized, double-blind, triple-crossover trial that challenges the long-standing "mantra" of using beta blockers as first-line therapy for non-obstructive hypertrophic cardiomyopathy (HCM). Dr. Bjerregaard explains how the study compared bisoprolol, verapamil, and placebo, revealing that bisoprolol actually resulted in a...

Dr. James MacNamara welcomes Dr. Milind Desai from the Cleveland Clinic to dissect the results and implications of the ODYSSEY trial, the largest study ever conducted in hypertrophic cardiomyopathy (HCM). The trial investigated the use of mavacamten in patients with non-obstructive HCM, a population with significant unmet medical needs. While the study did not reach statistical significance for it...

Dr. John Fritzlen sits down with Dr. Hunain Shiwani to discuss a paradigm shift in diagnosing hypertrophic cardiomyopathy (HCM). For 50 years, the medical community has relied on a static 15mm wall thickness threshold that fails to account for individual body size, age, and biological sex; a bias that often leaves female patients underdiagnosed. Dr. Shiwani details his team’s groundbreaking resear...

In this episode of In the Thick of It , Dr. John Fritzlen joins leading electrophysiologist Dr. Mark Link and Hannah and Bethany from Heart Charged to discuss the critical role of implantable cardioverter-defibrillators (ICDs) in managing hypertrophic cardiomyopathy. The group navigates the complex clinical landscape of ICD indications, including the importance of MRI findings and specific risk fa...

In this episode of In the Thick of It , Dr. Floridian Rader and Dr. Ahmad Masri discuss the transformative results of the MAPLE trial, a head-to-head study comparing aficamten—a cardiac myosin inhibitor—to metoprolol in patients with symptomatic obstructive hypertrophic cardiomyopathy1. The trial utilized a rigorous "double-dummy" design to ensure blinding while testing both medications at therape...

In this episode of In the Thick of It , Dr. Madeline Smoot talks with Dr. Alex McNamara to discuss the complexities of managing refractory symptoms in patients with hypertrophic cardiomyopathy (HCM). The conversation highlights the distinction between obstructive and non-obstructive symptoms, emphasizing the importance of provocative testing—such as cardiopulmonary exercise testing (CPET) and gold...

In this episode of In the Thick of It , genetic counselor Matthew Thomas sits down with Dr. Roddy Walsh and Dr. Juan Pablo Ochoa to discuss their groundbreaking research on the genetic architecture of Hypertrophic Cardiomyopathy (HCM). The conversation centers on "Intermediate Effect Variants" (IEVs)—genetic markers that fall between rare, high-impact Mendelian mutations and common, low-impact pol...

Dr. James MacNamara and Dr. Betty Raman recap the latest annual Hypertrophic Cardiomyopathy Society (HCMS) meeting held in New Orleans. The discussion emphasizes that HCM care is a "team sport," involving a multidisciplinary coalition of physicians, pharmacists, and advanced practice providers. Key highlights include a deep dive into Professor Hugh Watkins' lecture on the future of gene therapy an...

In this episode of In the Thick of It , Dr. James MacNamara sits down with Dr. Sharlene Day, Director of Translational Research at the University of Pennsylvania, to discuss the groundbreaking SONATA trial. This double-blind, placebo-controlled clinical trial is evaluating the safety and efficacy of sotagliflozin—a dual SGLT1 and SGLT2 inhibitor—in patients with both obstructive and non-obstructiv...

In this episode of In the Thick of It , hosts Dr. Betty Raman and Dr. James MacNamara welcome Professor Martin Maron, Director of the Hypertrophic Cardiomyopathy Center at Lahey Hospital & Medical Center, to discuss the innovative FORTITUDE-HCM study. This Phase 2b trial focuses on the symptomatic non-obstructive HCM population—a group considered to have one of the greatest unmet treatment nee...

In this episode of In the Thick of It , Dr. Betty Raman interviews Dr. Srihari Naidu, Director of the Hypertrophic Cardiomyopathy Medical Center at Westchester Medical Center, to explore what truly defines a "Center of Excellence". Dr. Naidu shares how his philosophy has evolved from a structural focus on advanced imaging and surgical tools to a patient-centered approach that prioritizes individua...

How can echocardiographers improve the accuracy and confidence of hypertrophic cardiomyopathy diagnosis? In this episode of In the Thick of It , sonographers Amy Dillenbeck and Brad Mehl explore the essential role of echocardiography in evaluating HCM, sharing best practices for optimizing imaging techniques, Doppler assessment, and contrast use. They discuss the most common challenges in detectin...

How do we determine which hypertrophic cardiomyopathy patients are at the highest risk for sudden cardiac death? In this episode of In the Thick of It , Dr. Steve Ommen and Dr. Mark Link take a deep dive into the role of non-sustained ventricular tachycardia (NSVT) in risk assessment and ICD decision-making. They discuss how age, VT duration, and other clinical factors influence risk stratificatio...

How can late gadolinium enhancement (LGE) on cardiac MRI help predict sudden cardiac death risk in hypertrophic cardiomyopathy? In this episode of In the Thick of It , Dr. Christopher Kramer and Dr. Raymond Chan explore the clinical significance of LGE, from its role in ICD decision-making to the challenges of scar quantification. They discuss how to differentiate true myocardial scar from artifac...

How do hypertrophic cardiomyopathy and aortic valve disease intersect, and what makes managing these patients so challenging? In this episode of In the Thick of It , Dr. Srihari Naidu and Dr. Megan Coylewright explore the complexities of aortic valve replacement (TAVR) in patients with HCM. What challenges arise when HCM patients undergo aortic valve replacement, and how can these risks be mitigat...

How has genetic testing transformed the understanding and care of hypertrophic cardiomyopathy? In this episode of In the Thick of It , Dr. Victoria Parikh and genetic counselor Tia Moscarello from the Stanford Center for Inherited Cardiovascular Disease explore the powerful role of genetics in HCM diagnosis, family screening, and treatment. They discuss groundbreaking advancements like gene therap...

What are left ventricular apical aneurysms, and why do they pose such a high risk in hypertrophic cardiomyopathy patients? In this episode of In the Thick of It , Dr. Ethan Rowin and Dr. Jeffrey Geske delve into this rare but critical HCM phenotype. They discuss how to accurately define and detect apical aneurysms, the importance of advanced imaging techniques like contrast echocardiography and ca...

Why is early detection of hypertrophic cardiomyopathy in children so critical for effective treatment? In this episode of In the Thick of It, Dr. Matthew Martinez sits down with pediatric cardiologist Dr. Tess Saarel to explore the unique challenges of managing HCM in young patients. They discuss the importance of personalized risk assessments, the role of genetics in tailoring care, and the colla...

What makes managing common conditions like hypertension and sleep apnea uniquely challenging in hypertrophic cardiomyopathy patients? In this episode of In the Thick of It, Dr. Michael Ayers and Dr. Robyn Bryde tackle the complexities of treating comorbidities such as obesity and type 2 diabetes within the context of HCM. They delve into how obstructive physiology impacts treatment choices and sha...

What does it take for healthcare providers to meet the unique needs of HCM patients experiencing AFib? In this episode, Dr. Ethan Rowin and Dr. Jose Joglar delve into the critical topic of atrial fibrillation (AFib) in patients with hypertrophic cardiomyopathy (HCM). They discuss the heightened risk of stroke associated with AFib, the necessity for prompt anticoagulation, and the complexities of m...

In today’s episode of In the Thick Of It, Dr. Anna Woo is joined by Dr. Sharon Cresci for a conversation on hypertrophic cardiomyopathy and its genetic implications. What role does genetic testing play in identifying familial variants and whether inheriting a pathogenic variant will lead to disease? Learn about the importance of genetic testing, lifelong serial screening, collaborative treatment a...

On today's episode of 'In The Thick of It', Dr. Benjamin Van Boxtel welcomes Dr. Daniel Swistel and Dr. Joseph Dearani to discuss Septal Myectomy and mitral valve repair. Why is personalized patient care crucial when managing hypertrophic cardiomyopathy? Tune in as these specialists explore the importance of customized procedures, teamwork across disciplines, ongoing education, and staying abreast...

On this episode of 'In The Thick of It',  Dr. Steve Ommen joins Dr. Matthew Martinez to explain the latest changes and updates to the HCM guidelines. What is the importance of personalized patient care, shared decision-making, and lifestyle adjustments for HCM patients? Find out as Dr. Martinez and Dr. Ommen discuss risk assessment methodologies, effective management strategies for atrial fibrilla...

When should we make the critical decision to start Cardiac Myosin therapy in NYHA Class II HCM patients? Today, Dr. Patrycja Galazka is joined by Dr. Sara Saberi, Assistant Associate Professor in Cardiovascular Medicine and co-director of the Inherited Cardiomyopathy Program at the Frankel Cardiovascular Center. Together, we dive into the intricate world of Cardiac Myosin Inhibitors, addressing th...