How effective is cibendazoline in the treatment of hypertrophic cardiomyopathy?

The treatment of hypertrophic cardiomyopathy (HCM) is effective.

Hamada et al. first reported that cibendazoline can significantly reduce the outflow tract pressure difference in hypertrophic obstructive cardiomyopathy (HOCM). There have been reports abroad that cibendazoline is useful in the treatment of HCM and the effect is significant.

About Cibenzoline

Cibenzoline is a new class I antiarrhythmic drug. It can be administered orally or intravenously. In some European and American countries, it is sold under the trade name Cipralan. Cibendazoline is widely used in clinical practice for the treatment of cardiac arrhythmias.

As a Class I antiarrhythmic drug, cibendazoline regulates the electrical activity of the heart by affecting the ion channels of heart cells, especially sodium channels, thereby restoring normal heart rhythm.

The mechanism of action of cibendazoline in the treatment of hypertrophic cardiomyopathy

Cibendazoline has multiple mechanisms of action in the treatment of hypertrophic cardiomyopathy (HCM):

1. Negative inotropic effect on myocardium: Cibendazoline can reduce the contractility of myocardial cells by inhibiting the activity of sodium channels, thereby reducing the load of ventricular systole. This can help slow the progression of cardiac hypertrophy and reduce the load on the heart.

2. Directly improve diastolic function: Cibendazoline can also promote the improvement of ventricular diastolic function by dilating blood vessels during ventricular diastole. This helps reduce the impact of myocardial hypertrophy on ventricular diastolic function and improves the ability of the ventricles to fill and relax during diastole.

3. Correct arrhythmias: Patients with hypertrophic cardiomyopathy are often accompanied by arrhythmias, such as atrial fibrillation, supraventricular tachycardia, etc. Cibenzoline has antiarrhythmic effects and can help restore normal heart rhythm and reduce the onset of arrhythmias.

It should be noted that the specific treatment plan should be determined based on the patient's condition and the doctor's advice. As part of drug treatment, cibendazoline usually needs to be used rationally under the guidance of a doctor, and monitored and adjusted regularly.

Efficacy of cebenzoline in the treatment of hypertrophic cardiomyopathy

1. Hypertrophic cardiomyopathy with left ventricular outflow tract obstruction (HOCM)

Inada K et al. [1] reported that intravenous injection of cilabendazole can quickly and significantly reduce or even eliminate the outflow tract pressure difference of up to 110 mmHg in a patient with HOCM, and at the same time eliminate concurrent severe mitral regurgitation. A randomized controlled trial by Hamada M et al showed that after the application of cibendazolin, HOCM left ventricular end-diastolic pressure and outflow tract pressure difference were significantly reduced, not only reducing the resting pressure difference but also reducing the pressure difference after exercise. At the same time, the mitral valve E/A ratio measured by pulsed wave Doppler ultrasound increased significantly, and the left ventricular diastolic function improved.

2. Mid-left ventricular hypertrophic obstructive cardiomyopathy (MVHOCM)

A randomized controlled trial by Hamada M et al. confirmed that 2 hours and 3 months after oral administration of cilbenzoline, the pressure difference at the obstruction site in patients with MVHOCM was significantly reduced, and the left ventricular end-diastolic volume measured by echocardiography was significantly increased, and the E/A ratio was also significantly increased. The QT interval of the electrocardiogram was significantly shortened, and the cardiac function was significantly improved. It can be seen in the short term after treatment that the left ventricular systolic function is significantly suppressed; however, after 3 months of continuous treatment, the systolic function recovers or is only slightly suppressed, while the diastolic function is significantly improved after both short-term and long-term treatment, indicating that cibendazoline can be used as a first-line treatment for patients with MVHOCM.

3. Biventricular obstruction and isolated right ventricular hypertrophic obstructive cardiomyopathy

Ishikawa T et al. treated a HCM patient with both middle left ventricular and right ventricular outflow tract obstruction. After injection of cilbenzoline, the pressure in the middle of the left ventricle significantly decreased, while the pressure difference in the right ventricular outflow tract almost disappeared. With long-term oral administration of cibendazolin, the pressure difference between the two chambers was well controlled, and no obvious complications occurred.

4. Non-obstructive hypertrophic cardiomyopathy

Patients with non-obstructive hypertrophic cardiomyopathy generally have mild symptoms, and those without high-risk factors for sudden death generally have a better prognosis. The effect of cibendazoline on improving diastolic function by reducing obstructive pressure gradient and left ventricular afterload is not obvious in non-obstructed patients, and there is no significant change in the increase in diastolic coronary flow velocity and coronary reserve. This indicates that the negative inotropic effect of cibendazoline may be a more important mechanism in the treatment of HCM and is more suitable for the treatment of obstructive HCM. However, the treatment of cibendazoline is not the first choice for HCM without obstruction.

Summary

According to foreign literature reports, cibendazoline can significantly and quickly reduce the pressure difference at various obstructive sites in hypertrophic obstructive cardiomyopathy. Its efficacy is significantly better than that of β-blockers and non-dihydropyridine calcium channel blockers P. It also improves the diastolic function and clinical symptoms of hypertrophic myocardium. It is easy to use and has few adverse reactions. It may become the first-line drug for hypertrophic cardiomyopathy, especially hypertrophic obstructive cardiomyopathy.

References

[1]Guo Xiying, Fan Chaomei, Li Yishi. Research progress of cilbenzoline in the treatment of hypertrophic cardiomyopathy[J]. Chinese Journal of Clinical Pharmacology, 2014, 30(07):647-649+656.DOI:10.13699/j.cnki.1001-6821.2014.07.027.

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