Effect of mavacamten on left ventricular diastolic function and left atrial remodelling in obstructive hypertrophic cardiomyopathy

IF 2.9 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2026-08-01 Epub Date: 2026-01-31 DOI:10.1016/j.acvd.2026.01.006

Nicolas Cohen, Claire Lucas, Chiara Idini, Elsa Conte, Mary Philip, Gregoire Stolpe, Hélène Martel, Sylvie Quaranta, Gilbert Habib

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引用次数: 0

Abstract

Background

Obstructive hypertrophic cardiomyopathy (HCM) is characterized by dynamic left ventricular outflow tract (LVOT) obstruction, leading to disabling symptoms. Mavacamten, a selective cardiac myosin inhibitor, improves obstruction and symptoms. Its beneficial effects on left ventricular diastolic indices have been documented, whereas its impact on left atrial strain has only recently been explored.

Aim

To assess the effect of mavacamten on diastolic function, left atrial remodelling and ventricular filling pressures in patients with obstructive HCM.

Methods

In this prospective, single-centre study, 55 symptomatic patients with obstructive HCM (mean age 68 ± 12 years, 40% male) were evaluated before and after individualized mavacamten titration. Echocardiographic, clinical and biomarker parameters were collected at baseline and after stabilization: left atrial end-systolic volume (LAESV), E/E′ ratio, E/A ratio, peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS), LVOT gradients, left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and NYHA class.

Results

After a mean titration of 5 months (final median maintenance dose 5 mg/day), NYHA class improved from 2.5 to 1.4 (P < 0.001) and NT-proBNP decreased from 1431 to 158 pg/mL (P < 0.001). LVOT gradients dropped at rest (65.0 mmHg [41.0–89.0] to 12.0 mmHg [6.0–18.0], P < 0.001) and after Valsalva (101.0 mmHg [78.0–126.0] to 19.0 mmHg [10.0–28.0]; P < 0.001). Indexed LAESV declined from 50.8 to 39.9 mL/m² (P < 0.001) and E/E′ from 14.2 to 9.5 (P < 0.001). E/A ratio remained unchanged. PALS and PACS worsened (PALS: 20.0% to 18.0%, P = 0.003; PACS: 11.0% to 8.0%, P = 0.002).

Conclusions

In this prospective, observational study, mavacamten initiation was associated with improvements in diastolic parameters and reductions in left atrial volume, together with favourable changes in clinical and haemodynamic measures in patients with obstructive HCM. The observed decrease in atrial strain parameters may reflect persistent atrial mechanical dysfunction or delayed functional recovery. Further studies with longer follow-up and controlled designs are needed to clarify the long-term effects on atrial remodelling.

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马伐卡坦对梗阻性肥厚型心肌病左室舒张功能及左房重构的影响。

背景：梗阻性肥厚性心肌病（HCM）以动态左心室流出道（LVOT）阻塞为特征，导致致残症状。马伐卡坦是一种选择性心肌肌球蛋白抑制剂，可改善梗阻和症状。它对左心室舒张指数的有益作用已被证实，而它对左心房应变的影响直到最近才被探讨。目的：探讨马伐卡坦对梗阻性HCM患者舒张功能、左房重构及心室充血压力的影响。方法：在这项前瞻性单中心研究中，对55例有症状的阻塞性HCM患者（平均年龄68±12岁，40%男性）在个体化马伐卡坦滴药前后进行评估。收集基线和稳定后的超声心动图、临床和生物标志物参数：左心房收缩末期容积（LAESV）、E/E′比、E/A比、心房纵向应变峰（PALS）和心房收缩应变峰（PACS）、LVOT梯度、左室射血分数（LVEF）、n端前b型利钠肽（NT-proBNP）和NYHA分级。结果：平均滴药5个月后（最终中位维持剂量5mg/天），NYHA分级从2.5提高到1.4 （P2）。结论：在这项前瞻性观察性研究中，马伐camten起始与舒张参数改善和左房容积降低相关，并与阻塞性HCM患者临床和血流动力学指标的有利变化相关。观察到的心房应变参数下降可能反映了持续的心房机械功能障碍或延迟的功能恢复。需要更长的随访和对照设计的进一步研究来阐明对心房重构的长期影响。

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

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.