Concierge Cardiology · Chronic Management

Cardiomyopathy Management.

Personalized, physician-led cardiomyopathy management with direct access to your cardiology team. Proactive monitoring. Faster interventions. Better outcomes.

Kunal U. Gurav, MD
Kunal U. Gurav, MD, Echocardiography & Nuclear Cardiology
1 in 500 people have HCM — the leading cause of sudden cardiac death in young athletes
Hcm Prevalence
Dilated cardiomyopathy accounts for nearly 50% of all heart transplants
Dcm Prevalence
Cardiac amyloidosis is underdiagnosed — estimated 300,000-500,000 Americans affected
Amyloidosis
Overview

Understanding cardiomyopathy management.

Cardiomyopathies — diseases of the heart muscle — represent a diverse group of conditions that collectively affect millions of Americans. Dilated cardiomyopathy (DCM) is the most common, affecting approximately 1 in 250-500 people and accounting for nearly half of all heart transplants. Hypertrophic cardiomyopathy (HCM) affects 1 in 500 people (approximately 660,000 Americans) and is the leading cause of sudden cardiac death in young athletes. Arrhythmogenic right ventricular cardiomyopathy (ARVC), restrictive cardiomyopathy, and cardiac amyloidosis round out the major subtypes, each with distinct management requirements. The 2024 AHA/ACC Hypertrophic Cardiomyopathy guidelines and the emergence of disease-modifying therapies — mavacamten for obstructive HCM, tafamidis for transthyretin cardiac amyloidosis — have transformed cardiomyopathy management from purely supportive care to targeted intervention. Cardiac MRI with late gadolinium enhancement has become essential for diagnosis, risk stratification, and monitoring, providing tissue characterization that echocardiography alone cannot offer. Our concierge cardiomyopathy program integrates advanced imaging, genetic testing and counseling, guideline-directed medical therapy, sudden death risk stratification, and family screening into a comprehensive management plan tailored to each patient's specific cardiomyopathy subtype.

Why Concierge

Why concierge cardiology for this condition.

Cardiomyopathy management is among the most complex areas of cardiology. A patient with HCM needs regular sudden death risk assessment using the HCM Risk-SCD calculator, serial imaging to track wall thickness and outflow gradients, exercise restriction counseling, genetic testing with cascade screening of relatives, and — for obstructive disease — consideration of mavacamten, septal myectomy, or alcohol septal ablation. A patient with cardiac amyloidosis needs technetium pyrophosphate scanning for diagnosis, genetic testing for hereditary ATTR, and tafamidis therapy that costs over $200,000/year and requires insurance navigation. These are not conditions that can be managed in a 15-minute visit every six months. Concierge care provides 60-minute quarterly visits with cardiomyopathy-focused evaluation, cardiac MRI coordination and detailed interpretation with imaging specialists, genetic testing with pre- and post-test counseling, same-day access for new symptoms such as syncope, presyncope, or worsening dyspnea, and proactive family screening protocols that can detect disease in relatives before sudden death occurs.

What we monitor.

Serial echocardiography: LV dimensions, wall thickness, LVEF, LVOT gradient (HCM), diastolic function
Cardiac MRI with late gadolinium enhancement for fibrosis quantification and risk stratification
NT-proBNP and troponin trends as markers of disease progression and treatment response
Holter or ambulatory monitoring for nonsustained VT — a key sudden death risk factor
Genetic testing results with variant classification updates as databases expand
Exercise capacity via cardiopulmonary exercise testing (CPET) with peak VO2 and VE/VCO2 slope
Iron studies, TTR (transthyretin), and technetium pyrophosphate scan for amyloidosis screening in HFpEF patients over 65

Our management approach.

Phenotype-specific therapy: GDMT for DCM, mavacamten for obstructive HCM, tafamidis for ATTR amyloidosis
Sudden cardiac death risk stratification using validated calculators and ICD implantation when indicated
Cardiac MRI at diagnosis and every 2-3 years for disease progression and fibrosis surveillance
Genetic testing with counseling through a cardiogenetics program and cascade screening of first-degree relatives
Exercise prescription: individualized activity recommendations based on diagnosis (competitive sport restriction for HCM per 2024 guidelines)
Advanced heart failure therapy evaluation: LVAD and transplant candidacy assessment when disease progresses
Clinical trial access and awareness for emerging therapies in cardiomyopathy subtypes

Expected outcomes.

Sudden cardiac death risk reduced by 70%+ with appropriate ICD placement guided by validated risk models
LVOT gradient reduction of 50%+ in obstructive HCM patients treated with mavacamten (EXPLORER-HCM trial)
GDMT optimization in DCM achieving LVEF improvement of 10-20% in up to 40% of patients within 12 months
Identification of pathogenic genetic variants enabling early detection in at-risk family members
Improved functional capacity and quality of life through individualized exercise programs and symptom management

Related concierge services.

Hypertension Management
Heart Failure Monitoring
Atrial Fibrillation Management

Get specialized concierge cardiomyopathy care with advanced imaging, genetic testing, and expert management.

Direct physician access, proactive monitoring, and personalized care plans. Concierge cardiology starting at $295/month.

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