Cardiac myosin inhibitors for hypertrophic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials.

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL

Annals of Medicine and Surgery Pub Date : 2025-04-29 eCollection Date: 2025-06-01 DOI:10.1097/MS9.0000000000003326

Uswa Hasana, Mayank Korpal, Faseeh Haider, Mohammad Umer, Nang Phyu Thant Lwin, Sohaba Iqbal, Rajanikant Kumar, Maria Ahsan, Ebaad Hassan, Waheed Ullah, Saif Khalid, Akhil Gupta, Asma'a Munasar Ali Alsubari, Muhammad Ehsan, Adeel Ahmad

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引用次数: 0

Abstract

Background/objective: HCM is a structural disorder of the myocardium that leads to sudden cardiac death in young adults. We synthesized an updated understanding of the role of Cardiac Myosin Inhibitors (CMIs) in HCM by pooling data from RCTs.

Methods: We identified six published RCTs, involving 826 participants. Data were extracted pertaining to study characteristics; primary outcomes of interest-(1) change from baseline in resting left ventricular outflow tract (LVOT) peak gradient, (2) change from baseline in Valsalva LVOT peak gradient, and (3) improvement of ≥1 NYHA class-and secondary outcomes. These were pooled using Review Manager 5.4, employing a random-effects model, and reported as odds ratios (ORs) or mean differences (MDs).

Results: We found statistically significant between-group difference favoring CMIs in change from baseline in LVOT peak gradient: at rest (MD -39.33; -53.01 to -25.64), post-Valsalva (MD -48.99; -53.96 to -44.03), and post-exercise (MD -37.11; -44.34 to -29.87); ≥1 NYHA class improvement (OR 4.10; 2.79-6.02), change from baseline in peak oxygen uptake (MD -37.11; -44.34 to -29.87), LVOT gradient ≤30 mm hg (RR 14.89; 7.47-29.67), participants eligible for septal reduction therapy (RR 0.26; 0.18-0.36), and change from baseline in KCCQ-CSS score (MD 8.54; 5.36-11.71). Subgrouping by intervention type (mavacamten vs. aficamten) revealed non-significant results for all primary outcomes.

Conclusions: CMIs can contribute to improving key efficacy outcomes for patients with HCM while reducing incidence of SRT.

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心肌肌球蛋白抑制剂治疗肥厚性心肌病：随机对照试验的系统回顾和荟萃分析。

背景/目的：HCM是一种心肌结构紊乱，可导致年轻人心源性猝死。我们通过汇总来自随机对照试验的数据，综合了对心肌肌球蛋白抑制剂（CMIs）在HCM中的作用的最新理解。方法：我们选取了6项已发表的随机对照试验，涉及826名受试者。根据研究特征提取数据；研究的主要结局是：(1)静息左心室流出道（LVOT）峰值梯度与基线相比的变化，(2)Valsalva LVOT峰值梯度与基线相比的变化，(3)≥1 NYHA分级和次要结局的改善。使用Review Manager 5.4对这些数据进行汇总，采用随机效应模型，并以比值比（ORs）或平均差异（MDs）进行报告。结果：我们发现cmi在LVOT峰值梯度与基线变化方面的组间差异具有统计学意义：静止时(MD -39.33；-53.01 ~ -25.64)， valsalva后(MD -48.99；-53.96 ~ -44.03)，运动后(MD -37.11；-44.34 - -29.87)；≥1个NYHA分级改善(OR 4.10；2.79-6.02)，峰值摄氧量与基线的变化(MD -37.11；-44.34 ~ -29.87)， LVOT梯度≤30 mm hg (RR 14.89；7.47-29.67)，受试者有资格接受间隔缩小治疗(RR 0.26；0.18-0.36)， KCCQ-CSS评分与基线的变化(MD 8.54；5.36 - -11.71)。按干预类型（mavacamten vs. aficamten）分组显示，所有主要结果均无显著性结果。结论：CMIs有助于改善HCM患者的关键疗效结果，同时降低SRT的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-

自引率

5.90%

发文量

1665