Table 1 Clinical similarities and differences between oHCM and nHCM as reported by clinical experts
Are there differences between oHCM and nHCM with regard to: | Clinician 1 (Italy) | Clinician 2 (US) | Clinician 3 (France) |
|---|---|---|---|
Number of symptoms? | • Obstructive patients have more reproducible and constant symptoms | • Obstructive patients have more symptoms | • (Clinician did not provide answer to this question directly) |
Types of symptoms? | • Obstructive patients experience palpitations and syncope after effort (recovery phase); not as typical for nonobstructive patients • Syncope on effort is rare, and a worrying sign of severity and instability | • Obstructive patients experience more light-headedness | • Obstructive patients have more frequent shortness of breath with exercise, dyspnea, and angina • Dizziness and palpitations are also more likely with obstruction |
Severity of symptoms? | • Obstructive patients experience more severe symptoms | • Obstructive patients perhaps experience more severe symptoms • Symptoms show up earlier in the disease course so they progress more than in nonobstructive patients | • More severe with obstruction |
Frequency of symptoms? | • Patients with oHCM have more frequent and reproducible symptoms than those with nHCM • Non-obstructed patients are much more variable and difficult to reproduce symptoms in | • Not really; once symptoms show up, they are there | • More frequent with obstruction |
Impacts of symptoms? | • Obstructive patients have more symptoms, more severe symptoms, and are more consistently symptomatic • When someone nonobstructive gets progressive symptoms, this is harder to deal with because it is harder to treat | • Patients with more symptoms and those more functionally disabled tend to be more depressed, so perhaps a greater proportion of patients with obstructive disease are depressed because they tend to have more severe symptoms earlier in the disease | • Symptoms are nonspecific so you must rely on more solid parameters (degree of thickness and obstruction, fibrosis, and arrhythmias), but because obstruction can lead to more severe symptoms, it can lead to more impacts |
Psychological impact of HCM? | • All clinicians stated that there were psychological impacts associated with HCM and that it was most common for patients to have anxiety, especially after the initial diagnosis • Generally, the clinicians thought that obstructive patients experienced a greater psychological impact as a result of the greater severity of their symptoms compared with nonobstructive patients • Overall, clinicians perceived the patients with the most severe symptoms as more likely to experience a psychological impact | ||