{"schema_version":"bookimed.page-context.v1","id":"nonobstructive-apical-hcm","url":"https://hub.bookimed.com/heart-surgery/nonobstructive-apical-hcm/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/nonobstructive-apical-hcm.json","index_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/index.json","full_dataset_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/content.json","content_revision":"source-driven-rankings-20261008","date_modified":"2026-10-08","language":"en","kind":"guide","title":"Nonobstructive and apical HCM: treatment decisions","summary":"Nonobstructive HCM lacks outflow obstruction; apical HCM describes thickening near the heart’s tip. Treatment targets the actual cause of symptoms. Routine outflow myectomy is not the default for either label.","research_credit":{"name":"Yevhenii Kozlov","role":"Co-Founder of Bookimed","url":"https://us-uk.bookimed.com/ceo/kozlov/","contribution":"Research personally prepared and reviewed","assistance":"AI tools assisted source research."},"editorial_scope":"Source-based patient information; an individual treatment plan requires clinical review.","research_method":"How this guide is researched and compared Research project led by Yevhenii Kozlov . We link clinical guidance, primary studies and named hospital or offer sources beside the relevant statements. Comparisons distinguish individual operators from programme results and preserve the study population, follow-up and limitations. Prices are dated examples with their stated scope. Research and editorial preparation are separate from clinical review; no named clinician has medically reviewed this edition. Bookimed provides care coordination. Partner and reference programmes are identified from their sources; paid ordering is not used in our published-cohort comparison. Read the editorial policy .","key_takeaways":[{"label":"Apical surgery is a selected option","text":"Guidance allows expert-centre consideration for severe persistent symptoms, preserved pumping function and a very small ventricular cavity.","sources":["D07"]},{"label":"580 patients in ODYSSEY-HCM","text":"At 48 weeks, mavacamten did not significantly outperform placebo on the two primary outcomes in nonobstructive HCM.","sources":["DX05"]},{"label":"Rhythm care continues","text":"Symptom treatment, sudden-death risk assessment and family screening remain distinct parts of HCM care.","sources":["C10"]}],"benefits":[{"text":"A mechanism-based assessment separates impaired filling, hidden exertional obstruction and rhythm problems, preventing the wrong treatment pathway.","sources":["C10"]}],"limitations":[{"text":"Benefits of drugs or surgery studied in obstructive HCM cannot simply be transferred to nonobstructive or apical disease.","sources":["DX05","D07"]}],"sections":[{"id":"benefit-balance","title":"Benefits and trade-offs","text":"Benefits and trade-offs Potential advantages A mechanism-based assessment separates impaired filling, hidden exertional obstruction and rhythm problems, preventing the wrong treatment pathway. Sources: AHA/ACC HCM guidance (2024) Trade-offs and limits Benefits of drugs or surgery studied in obstructive HCM cannot simply be transferred to nonobstructive or apical disease. Sources: Mavacamten in symptomatic nonobstructive hypertrophic cardiomyopathy: ODYSSEY-HCM · 2024 HCM guideline: official teaching slides","links":[{"label":"AHA/ACC HCM guidance (2024)","url":"https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/05/06/15/12/2024-hypertrophic-cardiomyopathy-gl"},{"label":"Mavacamten in symptomatic nonobstructive hypertrophic cardiomyopathy: ODYSSEY-HCM","url":"https://doi.org/10.1056/NEJMoa2505927"},{"label":"2024 HCM guideline: official teaching slides","url":"https://professional.heart.org/-/media/PHD-Files/Education/2024_HCM_Guideline_for_the_Management_of_HCM_Slide_Deck.pdf"}]},{"id":"diagnosis","title":"First establish what is causing the symptoms","text":"First establish what is causing the symptoms A small, stiff pumping chamber can cause symptoms without outflow obstruction. Exertional obstruction is a separate mechanism that may be missed on a resting scan. Cardiac MRI can clarify apical anatomy when ultrasound is inconclusive. Apical thickening does not by itself establish a high outflow gradient. Demonstrated exertional obstruction leads to the latent-obstruction pathway. Sources: AHA/ACC HCM guidance (2024) · Hypertrophic cardiomyopathy: diagnosis and treatment Latent obstruction & SAM ↗ HCM & myectomy ↗","links":[{"label":"AHA/ACC HCM guidance (2024)","url":"https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/05/06/15/12/2024-hypertrophic-cardiomyopathy-gl"},{"label":"Hypertrophic cardiomyopathy: diagnosis and treatment","url":"https://www.mayoclinic.org/diseases-conditions/hypertrophic-cardiomyopathy/diagnosis-treatment/drc-20350204"},{"label":"Latent obstruction & SAM ↗","url":"https://hub.bookimed.com/heart-surgery/latent-obstructive-hcm/"},{"label":"HCM & myectomy ↗","url":"https://hub.bookimed.com/heart-surgery/hcm-myectomy/"}]},{"id":"treatment","title":"What treatment can address","text":"What treatment can address Finding Treatment role Important limit Symptoms with preserved pumping function and no obstruction Medicines may reduce breathlessness or chest discomfort and manage congestion Relief of symptoms does not remove rhythm-risk and family-screening needs Apical thickening and a very small chamber Selected apical myectomy can create more useful cavity space This is a specialised option for severe persistent symptoms, not routine surgery for apical HCM Reduced pumping function or advanced heart failure Heart-failure treatment and possible transplant assessment Requires a different pathway from surgery directed at basal outflow obstruction Sources: 2024 HCM guideline: official teaching slides · AHA/ACC HCM guidance (2024) Heart failure, LVAD & transplant ↗","links":[{"label":"2024 HCM guideline: official teaching slides","url":"https://professional.heart.org/-/media/PHD-Files/Education/2024_HCM_Guideline_for_the_Management_of_HCM_Slide_Deck.pdf"},{"label":"AHA/ACC HCM guidance (2024)","url":"https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/05/06/15/12/2024-hypertrophic-cardiomyopathy-gl"},{"label":"Heart failure, LVAD & transplant ↗","url":"https://hub.bookimed.com/heart-surgery/heart-failure-surgery/"}],"tables":[[["Finding","Treatment role","Important limit"],["Symptoms with preserved pumping function and no obstruction","Medicines may reduce breathlessness or chest discomfort and manage congestion","Relief of symptoms does not remove rhythm-risk and family-screening needs"],["Apical thickening and a very small chamber","Selected apical myectomy can create more useful cavity space","This is a specialised option for severe persistent symptoms, not routine surgery for apical HCM"],["Reduced pumping function or advanced heart failure","Heart-failure treatment and possible transplant assessment","Requires a different pathway from surgery directed at basal outflow obstruction"]]]},{"id":"apical-surgery","title":"When apical myectomy may be considered","text":"When apical myectomy may be considered The 2024 guideline allows consideration of apical myectomy for highly selected patients with severe breathlessness or angina despite maximal medical therapy, preserved ejection fraction and a small left-ventricular cavity. It is a limited recommendation for experienced surgeons at comprehensive HCM centres. Apical myectomy aims to enlarge a small ventricular cavity. It differs from basal myectomy intended to relieve outflow obstruction, so published basal-myectomy outcomes do not automatically describe this operation. Sources: 2024 HCM guideline: official teaching slides · Hypertrophic cardiomyopathy: diagnosis and treatment","links":[{"label":"2024 HCM guideline: official teaching slides","url":"https://professional.heart.org/-/media/PHD-Files/Education/2024_HCM_Guideline_for_the_Management_of_HCM_Slide_Deck.pdf"},{"label":"Hypertrophic cardiomyopathy: diagnosis and treatment","url":"https://www.mayoclinic.org/diseases-conditions/hypertrophic-cardiomyopathy/diagnosis-treatment/drc-20350204"}]},{"id":"drug-evidence","title":"Why obstructive-HCM drug results do not transfer automatically","text":"Why obstructive-HCM drug results do not transfer automatically In ODYSSEY-HCM, published in 2025, 580 adults with symptomatic nonobstructive HCM were assigned to mavacamten or placebo for 48 weeks. Neither primary measure—peak exercise oxygen uptake or patient-reported health status—improved significantly more with mavacamten. Falls in ejection fraction and treatment interruptions were more frequent with the drug. The result applies to the studied drug, population and duration. Evidence from obstructive HCM cannot be transferred automatically to nonobstructive disease, and a clinical-trial treatment remains distinct from established care. Sources: Mavacamten in symptomatic nonobstructive hypertrophic cardiomyopathy: ODYSSEY-HCM","links":[{"label":"Mavacamten in symptomatic nonobstructive hypertrophic cardiomyopathy: ODYSSEY-HCM","url":"https://doi.org/10.1056/NEJMoa2505927"}]},{"id":"ongoing-care","title":"Symptom treatment and rhythm protection are separate decisions","text":"Symptom treatment and rhythm protection are separate decisions Rhythm assessment, sudden-death risk review and family screening remain parts of HCM care even if symptoms improve. An apical aneurysm is a separate imaging finding relevant to risk assessment. Sources: AHA/ACC HCM guidance (2024) Compare clinics ↗ Specialists ↗","links":[{"label":"AHA/ACC HCM guidance (2024)","url":"https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/05/06/15/12/2024-hypertrophic-cardiomyopathy-gl"},{"label":"Compare clinics ↗","url":"https://hub.bookimed.com/heart-surgery/clinics/"},{"label":"Specialists ↗","url":"https://hub.bookimed.com/heart-surgery/surgeons/"}]},{"id":"matching-specialists","title":"Specialists for this treatment pathway","text":"Specialists for this treatment pathway Explore each specialist’s clinical focus, current programme and the studies relevant to this treatment. The listed roles include cardiac surgeons and, where appropriate, interventional cardiologists. JD Rochester, Minnesota · United States cardiac surgeon Joseph A. Dearani → Joseph Dearani’s Mayo practice spans HCM, Ebstein anomaly, congenital surgery and complex reoperations. Mayo’s selected apical-myectomy research addresses a different problem from routine basal septal obstruction. Mayo Clinic Rochester → Sources: Mayo Clinic · HCM treatment options · Mayo · 67 patients with apical aneurysm repair View expertise and research → Browse the full specialist directory →","links":[{"label":"Joseph A. Dearani →","url":"https://hub.bookimed.com/heart-surgery/doctor-joseph-dearani/"},{"label":"Mayo Clinic Rochester →","url":"https://hub.bookimed.com/heart-surgery/clinic-mayo-rochester/"},{"label":"Mayo Clinic · HCM treatment options","url":"https://www.mayoclinic.org/diseases-conditions/hypertrophic-cardiomyopathy/diagnosis-treatment/drc-20350204"},{"label":"Mayo · 67 patients with apical aneurysm repair","url":"https://pubmed.ncbi.nlm.nih.gov/37029070/"},{"label":"View expertise and research →","url":"https://hub.bookimed.com/heart-surgery/doctor-joseph-dearani/"},{"label":"Browse the full specialist directory →","url":"https://hub.bookimed.com/heart-surgery/surgeons/"}]}],"introduction":"Heart surgery guide / Nonobstructive & apical HCM Nonobstructive & apical HCM · Decision guide Nonobstructive and apical HCM: treatment decisions The treatment pathway depends on obstruction, symptoms and cavity size—not wall thickness alone. Research by Yevhenii Kozlov · Co-Founder of Bookimed Updated 8 October 2026 Sources linked throughout At a glance Nonobstructive HCM lacks outflow obstruction; apical HCM describes thickening near the heart’s tip. Treatment targets the actual cause of symptoms. Routine outflow myectomy is not the default for either label. Apical surgery is a selected option Guidance allows expert-centre consideration for severe persistent symptoms, preserved pumping function and a very small ventricular cavity. Sources: 2024 HCM guideline: official teaching slides 580 patients in ODYSSEY-HCM At 48 weeks, mavacamten did not significantly outperform placebo on the two primary outcomes in nonobstructive HCM. Sources: Mavacamten in symptomatic nonobstructive hypertrophic cardiomyopathy: ODYSSEY-HCM Rhythm care continues Symptom treatment, sudden-death risk assessment and family screening remain distinct parts of HCM care. Sources: AHA/ACC HCM guidance (2024)","related_documents":[{"id":"heart-surgery","title":"Heart surgery abroad: treatments, clinics and costs","kind":"home","url":"https://hub.bookimed.com/heart-surgery/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/heart-surgery.json"},{"id":"hcm-myectomy","title":"Septal myectomy for obstructive HCM: compare treatment options","kind":"guide","url":"https://hub.bookimed.com/heart-surgery/hcm-myectomy/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/hcm-myectomy.json"},{"id":"clinics","title":"Heart surgery clinics: compare techniques and specialist teams","kind":"directory","url":"https://hub.bookimed.com/heart-surgery/clinics/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/clinics.json"},{"id":"surgeons","title":"Find cardiac surgeons and heart specialists by procedure","kind":"surgeons","url":"https://hub.bookimed.com/heart-surgery/surgeons/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/surgeons.json"},{"id":"second-opinion","title":"Prepare for a heart surgery second opinion","kind":"inquiry","url":"https://hub.bookimed.com/heart-surgery/second-opinion/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/second-opinion.json"},{"id":"latent-obstructive-hcm","title":"Latent obstructive HCM: exercise gradients, SAM and surgery","kind":"guide","url":"https://hub.bookimed.com/heart-surgery/latent-obstructive-hcm/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/latent-obstructive-hcm.json"},{"id":"heart-failure-surgery","title":"Heart failure surgery: underlying causes, LVAD and transplant","kind":"guide","url":"https://hub.bookimed.com/heart-surgery/heart-failure-surgery/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/heart-failure-surgery.json"},{"id":"doctor-joseph-dearani","title":"Joseph A. Dearani: HCM and congenital heart surgery","kind":"doctor-profile","url":"https://hub.bookimed.com/heart-surgery/doctor-joseph-dearani/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/doctor-joseph-dearani.json"},{"id":"clinic-mayo-rochester","title":"Mayo Clinic Rochester: heart surgery expertise","kind":"clinic-profile","url":"https://hub.bookimed.com/heart-surgery/clinic-mayo-rochester/","json_url":"https://hub.bookimed.com/wp-content/uploads/heart-surgery-hub-20261007/pages/clinic-mayo-rochester.json"}],"sources":{"C10":{"id":"C10","title":"2024 AHA/ACC/Multisociety Hypertrophic Cardiomyopathy Guideline: Key Points","url":"https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/05/06/15/12/2024-hypertrophic-cardiomyopathy-gl","publisher":"American College of Cardiology","published":"2024-05-08","read_at":"2026-10-07","source_type":"Professional society guideline summary"},"D07":{"id":"D07","title":"2024 HCM guideline: official teaching slides","url":"https://professional.heart.org/-/media/PHD-Files/Education/2024_HCM_Guideline_for_the_Management_of_HCM_Slide_Deck.pdf","publisher":"American Heart Association","read_at":"2026-10-07","source_type":"Official medical information or guideline"},"DX04":{"id":"DX04","title":"Hypertrophic cardiomyopathy: diagnosis and treatment","url":"https://www.mayoclinic.org/diseases-conditions/hypertrophic-cardiomyopathy/diagnosis-treatment/drc-20350204","publisher":"Mayo Clinic","published":null,"source_type":"Official hospital patient information and embedded specialist explanation; body inspected","read_at":"2026-10-08"},"DX05":{"id":"DX05","title":"Mavacamten in symptomatic nonobstructive hypertrophic cardiomyopathy: ODYSSEY-HCM","url":"https://doi.org/10.1056/NEJMoa2505927","publisher":"New England Journal of Medicine","published":"2025-08-30","source_type":"Primary randomized trial abstract; full article not retrieved","read_at":"2026-10-08"},"depth-mayo-hcm":{"title":"Mayo Clinic · HCM treatment options","url":"https://www.mayoclinic.org/diseases-conditions/hypertrophic-cardiomyopathy/diagnosis-treatment/drc-20350204","publisher":"Official hospital / clinical programme","read_at":"2026-10-08","label":"Mayo Clinic · HCM treatment options"},"depth-mayo-apical":{"title":"Mayo · 67 patients with apical aneurysm repair","url":"https://pubmed.ncbi.nlm.nih.gov/37029070/","publisher":"JTCVS / PubMed","read_at":"2026-10-08","label":"Mayo · 67 patients with apical aneurysm repair","retrieval":"Europe PMC full indexed abstract; online 2023, journal issue 2024"},"tp-hcm-guideline":{"title":"2024 AHA/ACC HCM guideline — ACC summary","url":"https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/05/06/15/12/2024-hypertrophic-cardiomyopathy-gl","kind":"professional society guideline summary","checked":"2026-10-08","accessed":"2026-10-08"},"pc-hcm-guideline":{"title":"2024 AHA/ACC multisociety HCM guideline key points","url":"https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/05/06/15/12/2024-hypertrophic-cardiomyopathy-gl","kind":"official society guideline summary","checked":"2026-10-08","accessed":"2026-10-08"}}}