EP News: Pediatric and Congenital Electrophysiology

  • Vicki A. Freedenberg
    Address reprint requests and correspondence: Dr Vicki A. Freedenberg, Division of Cardiology, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010.
    Division of Cardiology, Children’s National Hospital, Washington, District of Columbia
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Published:November 07, 2021DOI:
      Ho et al (Nat Med 2021;27:1818, PMID 34556856) conducted a multicenter, double-blind, placebo-controlled, phase 2 clinical trial to assess the safety and efficacy of angiotensin II receptor blocker valsartan in attenuating disease evolution in early hypertrophic cardiomyopathy (HCM). In total, 178 participants with early-stage sarcomeric HCM were randomized (1:1) to receive valsartan or placebo for 2 years. Standardized changes from baseline to year 2 in left ventricular wall thickness, mass, and volumes; left atrial volume; tissue Doppler diastolic and systolic velocities; and serum levels of high-sensitivity troponin T and N-terminal pro-B-type natriuretic protein were integrated into a single composite z score as the primary outcome. Valsartan (n = 88) improved cardiac structure and function compared with placebo (n = 90), as reflected by an increase in the composite z score (between-group difference 0.231; 95% confidence interval 0.098–0.364; P = .001), which met the primary end point of the study. Treatment was well-tolerated. The authors conclude that these results suggest an important opportunity to attenuate disease progression in early-stage sarcomeric HCM with a widely available and safe pharmacological intervention.
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