Mavacamten reduced LVOTO from median 96 to 32 mmHg after 3 months; increases in Sokolow-Lyon and Peguero-Lo Presti ECG indices predicted LVOTO worsening with 100% sensitivity.
Do electrocardiographic markers of left ventricular hypertrophy indicate therapeutic response to mavacamten in patients with hypertrophic obstructive cardiomyopathy?
Routine ECG markers of left ventricular hypertrophy, specifically the Sokolow-Lyon index and Peguero-Lo Presti criteria, can serve as a time- and resource-efficient tool to detect LVOTO progression and monitor therapeutic response in HOCM patients treated with mavacamten.
Absolute Event Rate: 0% vs 0%
Abstract Background Mavacamten has transformed treatment of hypertrophic obstructive cardiomyopathy (HOCM), but monitoring its therapeutic effects requires close, frequent, and time-intensive follow-ups with healthcare professionals. Assessing signs of left ventricular hypertrophy in routine electrocardiography (ECG) may serve as a novel, easily implementable, and accessible tool for predicting therapeutic response. Aims This study aims to evaluate ECG parameters for left ventricular hypertrophy (LVH) in patients with HOCM receiving mavacamten therapy. Methods All HOCM patients treated with mavacamten at the Heart Failure Unit of the study center between August 2023 and December 2024 were screened for inclusion. The first three months of therapy were assessed, including echocardiographic parameters, laboratory values, symptoms, and ECG markers of LVH. The Sokolow-Lyon index (sum of the S-wave in V1 and the R-wave in V5 or V6), Cornell criteria (sum of the S-wave in V3 and the R-wave in aVL), and Peguero-Lo Presti criteria (sum of the deepest S-wave in any lead and the S-wave in V4) were evaluated. Statistical analyses included linear regression, receiver operating characteristic (ROC) analysis, one-way ANOVA with post-hoc Tukey tests and non-parametric tests if non-normally distributed. Data are presented as mean ± standard deviation or median (interquartile range) if non-normally distributed. The study was approved by the local ethics committee (24-12165-BO). Results Screening identified 61 patients for inclusion. Patients were 57% male with a median age of 63 (46-80) years. Before starting treatment, all patients experienced dyspnoea classified as New York Heart Association (NYHA) II (53%) or NYHA III (47%). The median left ventricular outflow tract obstruction (LVOTO) was 37 (13-70) mmHg at rest, increasing to 96 (64-130) mmHg during Valsalva. Treatment with mavacamten resulted in a rapid and sustained reduction of LVOTO, with a median gradient of 32 (20-56) mmHg during Valsalva after 3 months of therapy (p 0.001). All ECG markers of LVH significantly decreased with treatment (Sokolow-Lyon index: 2.53 ± 1.00 mm versus (vs.) 1.96 ± 0.75 mm, p 0.01; Cornell criteria: 1.51 (0.92-2.21) mm vs. 1.22 (0.82-1.74) mm, p 0.01; Peguero-Lo Presti criteria: 2.57 ± 1.05 mm vs. 1.61 ± 0.58 mm, p 0.01; all pre vs. post mavacamten). Intraindividual increases in the Sokolow-Lyon index and Peguero-Lo Presti criteria correlated with increases in LVOTO during therapy (Sokolow-Lyon index: AUC 0.74, p 0.05; Cornell criteria: AUC 0.66, ns; Peguero-Lo Presti criteria: AUC 0.85, p 0.01). An increase in either the Sokolow-Lyon index or Peguero-Lo Presti criteria strongly indicated worsening LVOTO (sensitivity: 100%, specificity: 89.5%). Conclusion A combinatory ECG-based assessment using the Sokolow-Lyon index and Peguero-Lo Presti criteria may serve as a novel, time- and resource-efficient tool for detecting LVOTO progression during mavacamten therapy.
Buehning et al. (Sat,) reported a other. Mavacamten reduced LVOTO from median 96 to 32 mmHg after 3 months; increases in Sokolow-Lyon and Peguero-Lo Presti ECG indices predicted LVOTO worsening with 100% sensitivity.