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Artwork for In the Thick of It
Hypertrophic Cardiomyopathy
MAPLE Trial
Non-Obstructive Hypertrophic Cardiomyopathy
Odyssey Trial
Nonobstructive Hypertrophic Cardiomyopathy
Bisoprolol
Fortitude HCM
Implantable Cardioverter-Defibrillator
Intermediate Effect Variants
Neuroxastat
Sotagliflozin
Aficamten
Metoprolol
Imaging (MRI/ Echo)
Polygenic Risk Score
Center Of Excellence
Gene Therapy
Polygenic Risk Scores
Exercise In HCM
Cardiac Magnetic Resonance

Tune into our bi-monthly podcast where we interview experts in the field to broaden the awareness of new HCM studies & advancements!

PublishesDailyEpisodes36Founded3 years ago
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MedicineEducationHealth & Fitness

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Artwork for In the Thick of It

Latest Episodes

Patient advocates Hannah and Bethany Keime from HeartCharged sit down with Dr. John Fritzlen to discuss the long-term journey of living with hypertrophic cardiomyopathy (HCM). The conversation covers the progressive nature of the condition, including... more

Dr. Florian Rader joins Dr. Louise Bjerregaard to discuss a groundbreaking randomized, double-blind, triple-crossover trial that challenges the long-standing "mantra" of using beta blockers as first-line therapy for non-obstructive hypertrophic cardi... more

Dr. James MacNamara welcomes Dr. Milind Desai from the Cleveland Clinic to dissect the results and implications of the ODYSSEY trial, the largest study ever conducted in hypertrophic cardiomyopathy (HCM). The trial investigated the use of mavacamten ... more

Dr. John Fritzlen sits down with Dr. Hunain Shiwani to discuss a paradigm shift in diagnosing hypertrophic cardiomyopathy (HCM). For 50 years, the medical community has relied on a static 15mm wall thickness threshold that fails to account for indivi... more

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Recent Guests

John Fritzlen
HCM cardiologist
University of Kansas Medical Center
Episode: Long-Term Realities: Managing Disease Progression and ICD Selection in Young HCM Patients
Louise Bjergård
Lead author of the randomized trial on beta blockers vs verapamil in non-obstructive HCM
Aarhus University
Episode: Reevaluating Beta Blockers: New Evidence in Non-Obstructive HCM Care
Milind Desai
Vice chair of the Heart Vascular and Thoracic Institute at Cleveland Clinic; director of the Hypertrophic Cardiomyopathy Clinic
Cleveland Clinic
Episode: The ODYSSEY Continues: Deep Diving into Non-Obstructive HCM Data
Dr. Hunain Shiwani
Guest expert on HCM and imaging
[not explicitly listed in transcript]
Episode: The Personalized Heart: Moving Beyond the 15mm Rule in HCM Diagnosis
Mark Link
electrophysiologist, expert in HCM and ICDs
UT Southwestern Medical Center / HCM Center of Excellence
Episode: Bionic Tech and Shared Decisions: Exploring the Spectrum of ICD Care in HCM
Dr. Ahmad Masri
Guest expert, co-host at OHSU in Portland
Oregon Health & Science University
Episode: Redefining the Standard: Insights from the MAPLE Trial in Obstructive HCM
Roddy Walsh
Computational genomic scientist focusing on cardiomyopathies and arrhythmias
City, University of London (St George's), UK
Episode: The "Neglected Middle": Redefining HCM Genetics with Intermediate Effect Variants
Juan Pablo Ochoa
Cardiologist and geneticist
Spanish National Center for Cardiovascular Research, Hospital Huerta de Hierro, Madrid
Episode: The "Neglected Middle": Redefining HCM Genetics with Intermediate Effect Variants
Dr. Srihari Naidu
Renowned HCM specialist, director of the Hypertrophic Cardiomyopathy Medical Center at Westchester Medical Center
Westchester Medical Center
Episode: The Center of Excellence: Redefining Specialized Care in HCM

Hosts

James MacNamara
Host of In the Thick of It, Hypertrophic Cardiomyopathy and Imaging Specialist
Florian Rader
Host of In the Thick of It

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Talking Points

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Long-Term Realities: Managing Disease Progression and ICD Selection in Young HCM Patients
Q: What role do genetic factors play in progression and counseling for patients and their families?
Genetic mutations such as MYH7 and others can indicate a higher lifetime risk of cardiac events, so clinicians consider these factors when counseling patients about prognosis, monitoring, and family screening, and tailor conversations to the individual's genetic profile and family history.
Long-Term Realities: Managing Disease Progression and ICD Selection in Young HCM Patients
Q: How do doctors decide how aggressively to treat a newly diagnosed patient versus someone followed for many years?
Initial visits focus on establishing a baseline and discussing likely progression over the next five to ten years, with follow-ups gradually addressing longer-term scenarios. For patients followed over time, treatment can shift toward optimization, re-evaluating therapies, and considering emerging options like newer medications or device therapies as needed.
Long-Term Realities: Managing Disease Progression and ICD Selection in Young HCM Patients
Q: As a patient, tell us why HCM progresses and how age at diagnosis influences long-term outcomes.
Progression depends on age at onset, genetic factors, presence of obstruction, and symptoms. Younger patients may have a longer horizon of risk for heart failure, atrial fibrillation, and the need for advanced therapies, so prognosis and counseling should account for when the diagnosis occurred and how the disease evolves over decades.
Redefining the Standard: Insights from the MAPLE Trial in Obstructive HCM
Q: What were the main findings regarding metoprolol and the new agent?
Metoprolol did not improve peak VO2 as hoped and was associated with worsening NT-proBNP and left atrial volume, while the novel agent showed more favorable effects on the primary endpoint, suggesting a potential paradigm shift in first-line therapy for obstructive HCM.
Redefining the Standard: Insights from the MAPLE Trial in Obstructive HCM
Q: What were the goals of the MAPLE trial and why was it designed as a double-dummy blinded study?
The trial aimed to directly compare metoprolol against a novel agent to assess which provides better outcomes for obstructive HCM, using a double-dummy design to ensure blinding so that expectations and placebo effects do not bias results.

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Frequently Asked Questions About In the Thick of It

What is In the Thick of It about and what kind of topics does it cover?

These episodes center on hypertrophic cardiomyopathy (HCM), with a strong emphasis on cutting-edge clinical trials, diagnostic redefinitions, and patient-centered care. Conversations routinely feature leading researchers, clinicians, and trial investigators discussing trial design, novel therapies, imaging and genetics, and how results translate to real-world practice. A notable throughline is the tension between traditional-management approaches (e.g., beta blockers, implants) and emerging therapies, diagnostic criteria, and centers of excellence, all viewed through both expert and patient perspectives. The show frequently highlights multi-disciplinary decision making, evolving guidelines, and practical implications for patients, providers... more

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In the Thick of It launched 3 years ago and published 36 episodes to date. You can find more information about this podcast including rankings, audience demographics and engagement in our podcast database.

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What guests have appeared on In the Thick of It?

Recent guests on In the Thick of It include:

1. John Fritzlen
2. Louise Bjergård
3. Milind Desai
4. Dr. Hunain Shiwani
5. Mark Link
6. Dr. Ahmad Masri
7. Roddy Walsh
8. Juan Pablo Ochoa

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