Mavacamten significantly reduced mean Valsalva LVOT gradients from 72 mmHg at baseline to 30 mmHg at 12 weeks (p<0.001) and improved NYHA class in 64% of symptomatic oHCM patients.
Observational (n=150)
Yes
Does mavacamten improve NYHA class and reduce LVOT gradients in a real-world cohort of symptomatic obstructive hypertrophic cardiomyopathy patients?
In a real-world setting, mavacamten safely and effectively reduced LVOT gradients and improved heart failure symptoms in patients with obstructive hypertrophic cardiomyopathy.
p-value: p=< 0.001
BACKGROUND: In symptomatic obstructive hypertrophic cardiomyopathy (oHCM) patients, mavacamten is commercially approved to help improve left ventricular (LV) outflow tract (LVOT) gradients, symptoms, and reduce eligibility for septal reduction therapy (SRT) under the risk evaluation and mitigation strategy (REMS) program. We sought to prospectively report the initial real-world clinical experience with the use of commercially available mavacamten in a multi-hospital tertiary healthcare system. METHODS: We studied the first 150 consecutive oHCM patients (mean age 65 years, 53% women, 83% on betablockers and 61% in New York Heart Association NYHA class III) who were initiated on 5 mg of mavacamten with dose titrations using symptom assessment and echocardiographic measurements of LVOT gradient and LV ejection fraction (LVEF) measurements. We measured changes in NYHA class, LVEF, LVOT gradients (resting and Valsalva) at baseline, 4, 8 and 12 weeks. RESULTS: At 261 ± 143 days (range of 31-571 days), 69 (46%) patients had ≥1 NYHA class, and 27 (18%) additional patients had ≥2 NYHA class improvement. The mean Valsalva LVOT gradient decreased from 72 ± 43 mmHg at baseline to 29 ± 31 mmHg at 4 weeks, 29 ± 28 mmHg at 8 weeks and 30 ± 29 mmHg at 12 weeks (p < 0.001). At baseline, 100% patients had Valsalva LVOT gradients ≥30 mmHg, which reduced to 29% at 4 weeks, 28% at 8 weeks and 30% at 12 weeks. In 40 patients who reported no symptomatic improvement, the mean Valsalva LVOT gradient decreased from 73 ± 39 mmHg at baseline to 34 ± 27 mmHg at 4 weeks, 35 ± 28 mmHg at 8 weeks and 30 ± 24 mmHg at 12 weeks (P < 0.001). The mean LVEF at baseline was 66 ± 6% and changed to 64 ± 5% at 4 weeks, 63 ± 5% at 8 weeks and 62 ± 7% at 12 weeks (p < 0.0001). No patient underwent SRT, developed LVEF ≤30% or developed heart failure requiring admission. Three (2%) patients needed temporary interruption of mavacamten due to LVEF<50%. CONCLUSIONS: In a real-world study in symptomatic oHCM patients at a multi-hospital tertiary care referral center, we demonstrate the efficacy and safety, along with the logistic feasibility of prescribing mavacamten under the REMS program.
Desai et al. (Tue,) conducted a observational in symptomatic obstructive hypertrophic cardiomyopathy (oHCM) (n=150). mavacamten was evaluated on mean Valsalva LVOT gradient at 12 weeks (p=< 0.001). Mavacamten significantly reduced mean Valsalva LVOT gradients from 72 mmHg at baseline to 30 mmHg at 12 weeks (p<0.001) and improved NYHA class in 64% of symptomatic oHCM patients.