Hypertrophic Cardiomyopathy – 2nd Masterclass in Florence 2025

This is a time of great excitement in the cardiomyopathy field, particularly regarding hypertrophic cardiomyopathy. After many years of research and study, as well as treatment for these patients, we now have specific drugs available: myosin inhibitors. These drugs act directly on the disease mechanism, the molecular mechanism at the cardiac cell level. Therefore, they are very important, having proven highly effective and likely to change the course of this disease. For this reason, Professor Olivotto, Professor Cappelli, and I, with the support of Bristol Myers Squibb, have organized this second masterclass. It was designed to bring together all Italian hypertrophic cardiomyopathy experts to discuss the imminent arrival of these drugs and their use, some of which we have already tested during trials. We had around thirty speakers and approximately 150 cardiologists specializing in hypertrophic cardiomyopathy from all over Italy, so it was a very large event, with a significant effort from Bristol Myers Squibb, whom we obviously thank because with their support we were able to achieve something we could not have done alone as the University of Florence.

The masterclass was organized with an initial international day featuring experts from other European countries, particularly Professor Perry Elliott from London and Professor Roberto Barriales from A Coruña, representing centers that participated in the trials, as well as Florence. Therefore, the first day was truly international, with presentations by these experts, to whom all the physicians from the Italian centers present were able to directly address questions or discuss any unclear points or concerns. Over the following days, there were other very important presentations both on hypertrophic cardiomyopathy and these new drugs, but also on the therapies we have used so far, such as surgery, or the drugs we have used so far, with a view to how these therapies will change once these myosin inhibitors become available.

Of course, there were also practical sessions, particularly a genetics session that explained the usefulness and use of genetic testing in these patients and their families. Doctors then discussed how best to use genetic testing, what to expect, and how to manage genetic test results in patients with hypertrophic cardiomyopathy. There was a workshop on imaging, including echocardiography and magnetic resonance imaging, which are the tests we use not only to diagnose but also to monitor the effectiveness of treatments and the progression of cardiomyopathy. Another workshop focused specifically on therapies, on initial experiences with these new drugs and how to manage them in addition to other therapies, perhaps by reducing their dosage (e.g., beta-blockers) or even discontinuing them altogether. Participants also had the opportunity to present some of their patients' concerns, which were then discussed collectively.

The practical imaging section also included two patients receiving the new drugs that were evaluated by echocardiography by the participating physicians. They shared their experiences with these therapies and the impact they have had on their quality of life. These were very interesting moments, because hearing the effectiveness of a drug from the patients' perspective is much more valuable than reading about it in a study or article. We received thanks from all those who attended for the importance and usefulness of this event, and they invited us to repeat it next year.

The first one predated the availability of these drugs and was specifically aimed at diagnosing hypertrophic cardiomyopathy, to understand, together with other centers, the best approach, which tests should be performed, and how all the diagnostic tests should be performed to reach a precise diagnosis. We could call it the first preparatory masterclass, if we may say so, for this one.

Masterclasses in general, as the term "master" suggests, are events attended by doctors who are already experts in the disease. Therefore, it's a highly specialized approach that doesn't involve a true teacher-student relationship, but rather a discussion among super experts with more experience—not more knowledge, I'd say, but more experience—who can offer advice. There's also a greater practical value in the application of medicine because we're discussing, not just individual cases, but things experienced in clinical practice, on which we can seek advice from those with more experience. It's a truly useful exchange, which is why we're asked to continue doing it.

They play a fundamental role, and Professor Cecchi clearly explained this, presenting all the initiatives implemented in AICARM's six years of existence. AICARM is truly invaluable because it publicized the event among AICARM member physicians, but above all, over time, it has raised awareness among patients, also through courses for experienced patients, to bring their experiences to the attention of the medical community. Hearing from a patient who previously couldn't climb stairs how he can now ride a bicycle is an important test for guiding our clinical and research efforts.