Mavacamten treatment for 12 weeks significantly reduced resting peak LVOT gradient (average reduction -57 mmHg, p<0.0001) with no major changes in right-sided cardiac volumes.
Cohort (n=39)
Does mavacamten treatment affect right-sided echocardiographic parameters in patients with obstructive hypertrophic cardiomyopathy?
Mavacamten treatment for 12 weeks in oHCM patients significantly reduces pulmonary pressure and LVOT gradient without causing major changes in right atrial and right ventricular volumes or function.
Mean Difference: -57
p-value: p=<0.0001
Abstract Background Clinical guidelines indicate the use of the cardiac myosin inhibitor mavacamten for the treatment of symptomatic adult patients with obstructive HCM (oHCM) as it normalizes contractility, reduces dynamic left ventricular outflow tract (LVOT) obstruction, and improves cardiac filling pressures. Purpose In our study we aimed to investigate the effect of mavacamten treatment on right-sided echocardiographic parameters. Methods Thirty-nine oHCM patients 21 men (54%), mean age: 56±11 years were treated with mavacamten. In addition to recording the main demographic and clinical parameters, complete standard, 2D-speckle tracking and 3D volumetric and speckle tracking echocardiographic examination was performed in four-week intervals of treatment until 12 weeks (W12). Results As a main effect, resting peak LVOT gradient was significantly reduced (average reduction of -57 mmHg at W12, 0.0001). With regard to right-sided echocardiographic parameters, there was a slight non-significant increase from W0 to W12 in right atrial area from 16 cm2 (14 -20) to 18 cm2 (16-20), and a borderline-significant increase in right ventricular (RV) basal diameter 39 mm (36-43) to 40 mm (37-42), p=0.04683. RV length didn’t change significantly. Tricuspid annular plane systolic excursion (TAPSE) showed no significant change, but tricuspid annular s’ decreased from 13 cm/s (12-15) at W0 to 11.5 cm/s (9-13) at W12 (p=0.00001). Right ventricular free wall strain showed no significant change. Among 3D parameters, RV end-diastolic and end-systolic volume and volume index didn’t change significantly. RV ejection fraction and RV fractional area change (RV FAC) showed no significant change, either. Pulmonary pressure decreased from 42 mmHg at W0 to 31 Hgmm at W12 (p=0.0008), while RV-RA pressure gradient also decreased significantly [31 (27-36) vs. 25 (20-30) mmHg, p0.00001). Pulmonary acceleration time showed no significant change. Conclusions No major changes in RA and RV volumes and function could be detected during 12 weeks of mavacamten treatment.
Schvartz et al. (Thu,) conducted a cohort in obstructive hypertrophic cardiomyopathy (oHCM) (n=39). mavacamten vs. Baseline was evaluated on resting peak LVOT gradient (MD -57 mmHg, p=<0.0001). Mavacamten treatment for 12 weeks significantly reduced resting peak LVOT gradient (average reduction -57 mmHg, p<0.0001) with no major changes in right-sided cardiac volumes.