1
|
Haraf R, Habib H, Masri A. The Revolution of Cardiac Myosin Inhibitors in Patients With Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:800-819. [PMID: 38280487 DOI: 10.1016/j.cjca.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 01/29/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy worldwide and causes significant morbidity and mortality. For decades, medical treatment options have been limited and untargeted, with frequent need for invasive interventions not readily accessible to many HCM patients. More recently, our understanding of the genetic basis and pathophysiologic mechanism of HCM has grown significantly, leading to the discovery of a new class of medications, cardiac myosin inhibitors (CMIs), that shift myosin into the super-relaxed state to counteract the hypercontractility in HCM. Subsequent clinical trials have proven the mechanism and efficacy of CMIs in humans with obstructive HCM, and additional trials are under way in patients with nonobstructive HCM. With favourable results in the completed clinical trials and ongoing research on the horizon, CMIs represent a bright new era in the targeted management of HCM. This review is focused on the discovery of CMIs, provides a summary of the results of clinical trials to date, provides clinicians with a roadmap for implementing CMIs into practice, and identifies gaps in our current understanding as well as areas of ongoing investigation.
Collapse
Affiliation(s)
- Rebecca Haraf
- The Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Hany Habib
- The Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Ahmad Masri
- The Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
| |
Collapse
|
2
|
Vyas R, Panchal V, Jain S, Sondhi M, Singh M, Jaisingh K, Thotamgari SR, Thakre A, Modi K. Evaluating the efficacy and safety of mavacamten in hypertrophic cardiomyopathy: A systematic review and meta-analysis focusing on qualitative assessment, biomarkers, and cardiac imaging. PLoS One 2024; 19:e0301704. [PMID: 38635724 PMCID: PMC11025865 DOI: 10.1371/journal.pone.0301704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Hypertrophic Cardiomyopathy (HCM) is a complex cardiac condition characterized by hypercontractility of cardiac muscle leading to a dynamic obstruction of left ventricular outlet tract (LVOT). Mavacamten, a first-in-class cardiac myosin inhibitor, is increasingly being studied in randomized controlled trials. In this meta-analysis, we aimed to analyse the efficacy and safety profile of Mavacamten compared to placebo in patients of HCM. METHOD We carried out a comprehensive search in PubMed, Cochrane, and clinicaltrials.gov to analyze the efficacy and safety of mavacamten compared to placebo from 2010 to 2023. To calculate pooled odds ratio (OR) or risk ratio (RR) at 95% confidence interval (CI), the Mantel-Haenszel formula with random effect was used and Generic Inverse Variance method assessed pooled mean difference value at a 95% CI. RevMan was used for analysis. P<0.05 was considered significant. RESULTS We analyzed five phase 3 RCTs including 609 patients to compare mavacamten with a placebo. New York Heart Association (NYHA) grade improvement and KCCQ score showed the odds ratio as 4.94 and 7.93 with p<0.00001 at random effect, respectively. Cardiac imaging which included LAVI, LVOT at rest, LVOT post valsalva, LVOT post-exercise, and reduction in LVEF showed the pooled mean differences for change as -5.29, -49.72, -57.45, -36.11, and -3.00 respectively. Changes in LVEDV and LVMI were not statistically significant. The pooled mean difference for change in NT-proBNP and Cardiac troponin-I showed 0.20 and 0.57 with p<0.00001. The efficacy was evaluated in 1) A composite score, which was defined as either 1·5 mL/kg per min or greater increase in peak oxygen consumption (pVO2) and at least one NYHA class reduction, or a 3·0 mL/kg per min or greater pVO2 increase without NYHA class worsening and 2) changes in pVO2, which was not statistically significant. Similarly, any treatment-associated emergent adverse effects (TEAE), treatment-associated serious adverse effects (TSAE), and cardiac-related adverse effects were not statistically significant. CONCLUSION Mavacamten influences diverse facets of HCM comprehensively. Notably, our study delved into the drug's impact on the heart's structural and functional aspects, providing insights that complement prior findings. Further large-scale trials are needed to evaluate the safety profile of Mavacamten.
Collapse
Affiliation(s)
- Rahul Vyas
- Department of Internal Medicine, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Viraj Panchal
- Department of Medicine, Smt. NHL Municipal Medical College and SVPISMR, Ahmedabad, Gujarat, India
| | - Shubhika Jain
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | - Manush Sondhi
- Department of Internal Medicine, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Mansunderbir Singh
- Department of Internal Medicine, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Keerthish Jaisingh
- Department of Cardiology, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Sahith Reddy Thotamgari
- Department of Cardiology, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Anuj Thakre
- Department of Internal Medicine, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Kalgi Modi
- Department of Cardiology, Louisiana State University, Shreveport, Louisiana, United States of America
| |
Collapse
|
3
|
Benavente K, Moreno JP, Banerjee D. Withdrawal Of Atrioventricular Nodal Blocking Agents in Patients Receiving Mavacamten: A Retrospective Single-Center Experience in A Predominantly Asian-American Cohort. Am J Cardiol 2024; 216:63-65. [PMID: 38008348 DOI: 10.1016/j.amjcard.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Kevin Benavente
- Department of Medicine, The John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Jesus Pino Moreno
- Department of Medicine, The John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Dipanjan Banerjee
- Department of Medicine, The John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii.
| |
Collapse
|
4
|
Rehan ST, Ali A, Imran L, Ahmed J, Ullah I, Abdalla AS, Majid M, Asghar MS. Effects of Mavacamten Concomitant With Beta-Blockers on Patients With Hypertrophic Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials. Am J Ther 2024:00045391-990000000-00185. [PMID: 38563758 DOI: 10.1097/mjt.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
| | - Abraish Ali
- Dow University of Health Sciences, Karachi, Pakistan
| | - Laiba Imran
- Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Ahmed
- Dow University of Health Sciences, Karachi, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | | | | | | |
Collapse
|
5
|
Coats CJ, Maron MS, Abraham TP, Olivotto I, Lee MMY, Arad M, Cardim N, Ma CS, Choudhury L, Düngen HD, Garcia-Pavia P, Hagège AA, Lewis GD, Michels M, Oreziak A, Owens AT, Tfelt-Hansen J, Veselka J, Watkins HC, Heitner SB, Jacoby DL, Kupfer S, Malik FI, Meng L, Wohltman A, Masri A. Exercise Capacity in Patients With Obstructive Hypertrophic Cardiomyopathy: SEQUOIA-HCM Baseline Characteristics and Study Design. JACC Heart Fail 2024; 12:199-215. [PMID: 38032573 DOI: 10.1016/j.jchf.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
Patients with obstructive hypertrophic cardiomyopathy (oHCM) have increased risk of arrhythmia, stroke, heart failure, and sudden death. Contemporary management of oHCM has decreased annual hospitalization and mortality rates, yet patients have worsening health-related quality of life due to impaired exercise capacity and persistent residual symptoms. Here we consider the design of clinical trials evaluating potential oHCM therapies in the context of SEQUOIA-HCM (Safety, Efficacy, and Quantitative Understanding of Obstruction Impact of Aficamten in HCM). This large, phase 3 trial is now fully enrolled (N = 282). Baseline characteristics reflect an ethnically diverse population with characteristics typical of patients encountered clinically with substantial functional and symptom burden. The study will assess the effect of aficamten vs placebo, in addition to standard-of-care medications, on functional capacity and symptoms over 24 weeks. Future clinical trials could model the approach in SEQUOIA-HCM to evaluate the effect of potential therapies on the burden of oHCM. (Safety, Efficacy, and Quantitative Understanding of Obstruction Impact of Aficamten in HCM [SEQUOIA-HCM]; NCT05186818).
Collapse
Affiliation(s)
- Caroline J Coats
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom.
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center at Lahey Medical Center, Burlington, Massachusetts, USA
| | | | - Iacopo Olivotto
- Meyer Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Florence, Italy
| | - Matthew M Y Lee
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center, Israel; Tel Aviv University, Medical School, Israel
| | | | - Chang-Sheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lubna Choudhury
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro de Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Albert A Hagège
- Département de Cardiologie, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | | | | | | | - Anjali T Owens
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob Tfelt-Hansen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Josef Veselka
- University Hospital Motol and 2nd Medical School, Charles University, Prague, Czech Republic
| | - Hugh C Watkins
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Daniel L Jacoby
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Stuart Kupfer
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Fady I Malik
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Lisa Meng
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Amy Wohltman
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Ahmad Masri
- Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
6
|
Braunwald E, Saberi S, Abraham TP, Elliott PM, Olivotto I. Mavacamten: a first-in-class myosin inhibitor for obstructive hypertrophic cardiomyopathy. Eur Heart J 2023; 44:4622-4633. [PMID: 37804245 PMCID: PMC10659958 DOI: 10.1093/eurheartj/ehad637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 10/09/2023] Open
Abstract
Mavacamten is a first-in-class, targeted, cardiac-specific myosin inhibitor approved by the US Food and Drug Administration for the treatment of adults with symptomatic New York Heart Association Classes II and III obstructive hypertrophic cardiomyopathy (oHCM). Mavacamten was developed to target the hyper-contractile phenotype, which plays a critical role in the pathophysiology of the disease. In Phase 2 and 3 clinical trials, mavacamten was well tolerated, reduced left ventricular outflow tract gradients, improved exercise capacity and symptoms, and was associated with improvements in other clinically relevant parameters, such as patient-reported outcomes and circulating biomarkers. In addition, treatment with mavacamten was associated with evidence of favourable cardiac remodelling in multi-modality imaging studies. Mavacamten substantially reduced guideline eligibility for septal reduction therapy candidates with oHCM and drug-refractory symptoms. In this article, the available efficacy and safety data from completed and ongoing clinical studies of mavacamten in patients with symptomatic oHCM are reviewed. Longer term extension studies may help address questions related to the positioning of mavacamten in current oHCM management algorithms, interactions with background therapy, as well as the potential for disease modification beyond symptomatic relief of left ventricular outflow tract obstruction.
Collapse
Affiliation(s)
- Eugene Braunwald
- Division of Cardiovascular Medicine, TIMI Study Group, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
- Department Medicine, Harvard Medical School, Boston, MA, USA
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Theodore P Abraham
- UCSF HCM Center of Excellence, University of California San Francisco, San Francisco, CA, USA
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, London, UK
| | - Iacopo Olivotto
- Meyer Children’s Hospital, University of Florence, Florence, Italy
| |
Collapse
|
7
|
Weissler-Snir A, Rakowski H, Meyer M. Beta-blockers in non-obstructive hypertrophic cardiomyopathy: time to ease the heart rate restriction? Eur Heart J 2023; 44:3655-3657. [PMID: 37650505 DOI: 10.1093/eurheartj/ehad518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Affiliation(s)
- Adaya Weissler-Snir
- Hartford HealthCare, Heart and Vascular Institute, 80 Seymour St, Hartford, CT 06106, USA
- Department of Medicine, University of Connecticut Farmington, CT, USA
| | - Harry Rakowski
- The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON M5G 2N2, Canada
| | - Markus Meyer
- Lillehei Heart Institute, Department of Medicine, University of Minnesota, 2231 6th Street SE, Minneapolis, MN 55455, USA
| |
Collapse
|
8
|
Burban A, Pucyło S, Sikora A, Opolski G, Grabowski M, Kołodzińska A. Hypertrophic Cardiomyopathy versus Storage Diseases with Myocardial Involvement. Int J Mol Sci 2023; 24:13239. [PMID: 37686045 PMCID: PMC10488064 DOI: 10.3390/ijms241713239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
One of the main causes of heart failure is cardiomyopathies. Among them, the most common is hypertrophic cardiomyopathy (HCM), characterized by thickening of the left ventricular muscle. This article focuses on HCM and other cardiomyopathies with myocardial hypertrophy, including Fabry disease, Pompe disease, and Danon disease. The genetics and pathogenesis of these diseases are described, as well as current and experimental treatment options, such as pharmacological intervention and the potential of gene therapies. Although genetic approaches are promising and have the potential to become the best treatments for these diseases, further research is needed to evaluate their efficacy and safety. This article describes current knowledge and advances in the treatment of the aforementioned cardiomyopathies.
Collapse
Affiliation(s)
- Anna Burban
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
- Doctoral School, Medical University of Warsaw, 81 Żwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Szymon Pucyło
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Aleksandra Sikora
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Agnieszka Kołodzińska
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| |
Collapse
|
9
|
Ostrominski JW, Guo R, Elliott PM, Ho CY. Cardiac Myosin Inhibitors for Managing Obstructive Hypertrophic Cardiomyopathy: JACC: Heart Failure State-of-the-Art Review. JACC Heart Fail 2023; 11:735-748. [PMID: 37407153 DOI: 10.1016/j.jchf.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 07/07/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is frequently caused by pathogenic variants in genes encoding sarcomere proteins and is characterized by left ventricular (LV) hypertrophy, hypercontractility, and-in many cases-left ventricular outflow tract (LVOT) obstruction. Despite standard management, obstructive HCM (oHCM) can still cause substantial morbidity, highlighting the critical need for more effective disease-specific therapeutic approaches. Over the past decade, improved understanding of the molecular pathobiology of HCM has culminated in development of cardiac myosin inhibitors (CMIs), a novel drug class that in recent randomized clinical trials has been shown to decrease LVOT obstruction, improve exercise capacity, and ameliorate symptom burden in patients with oHCM. Although promising, areas of uncertainty remain, including the long-term safety and efficacy of CMIs and whether they have the potential to modify progression of disease. Herein, we review key milestones in the clinical development of CMIs, contextualize CMIs with established oHCM therapies, and discuss future challenges and opportunities for the use of CMIs across the HCM spectrum.
Collapse
Affiliation(s)
- John W Ostrominski
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ruby Guo
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Perry M Elliott
- Centre for Heart Muscle Disease, Institute of Cardiological Sciences, University College London and St Bartholomew's Hospital, London, United Kingdom
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
10
|
Argirò A, Zampieri M, Marchi A, Cappelli F, Del Franco A, Mazzoni C, Cecchi F, Olivotto I. Stage-specific therapy for hypertrophic cardiomyopathy. Eur Heart J Suppl 2023; 25:C155-C161. [PMID: 37125313 PMCID: PMC10132571 DOI: 10.1093/eurheartjsupp/suad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited myocardial disease and is defined by otherwise unexplained left ventricular hypertrophy. The main complications include heart failure and arrhythmias such as atrial fibrillation and ventricular arrhythmias. Current treatment rests on septal reduction therapies, prevention of sudden cardiac death through implantable cardioverter defibrillator, and use of drugs such as beta-blockers, calcium antagonists, or amiodarone. In the last years, new pharmacological agents specifically targeting the pathophysiology of the disease have been developed with encouraging results in terms of functional capacity and symptoms improvement from clinical trials. In this review, we summarize the possible treatment approaches for each phase of the natural history of the disease: pre-phenotype expression, classic phenotype, adverse remodelling, and overt dysfunction.
Collapse
Affiliation(s)
- Alessia Argirò
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Largo Brambilla, 3 50134 Florence, Italy
| | - Mattia Zampieri
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Largo Brambilla, 3 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Alberto Marchi
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Largo Brambilla, 3 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Largo Brambilla, 3 50134 Florence, Italy
| | - Annamaria Del Franco
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Largo Brambilla, 3 50134 Florence, Italy
| | - Carlotta Mazzoni
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Largo Brambilla, 3 50134 Florence, Italy
| | - Franco Cecchi
- Department of Cardiology, IRCCS Istituto Auxologico Italiano, Department of Cardiology, Ospedale San Luca, Milan, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Largo Brambilla, 3 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children Hospital, Florence, Italy
| |
Collapse
|
11
|
Rosenzveig A, Garg N, Rao SJ, Kanwal AK, Kanwal A, Aronow WS, Martinez MW. Current and emerging pharmacotherapy for the management of hypertrophic cardiomyopathy. Expert Opin Pharmacother 2023; 24:1349-1360. [PMID: 37272195 DOI: 10.1080/14656566.2023.2219840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) is one of the most common genetic causes of heart disease. Since the initial description of HCM, there have been minimal strides in management options. Obstructive HCM constitutes a larger subset of patients with increased left ventricular outflow tract gradients causing symptoms. Septal reduction therapy (SRT) has been successful, but it is not the answer for all patients and is not disease modifying. AREAS COVERED Current guideline recommendations include beta-blockers, calcium channel blockers, or disopyramides for medical management, but there lacks evidence of much benefit with these drugs. In recent years, there has been the emergence of cardiac myosin inhibitors (CMI) which have demonstrated positive results in patients with both obstructive and non-obstructive HCM. In addition to CMIs, other drugs have been investigated as we have learned more about HCM's pathological mechanisms. Drugs targeting sodium channels and myocardial energetics, as well as repurposed drugs that have demonstrated positive remodeling are being investigated as potential therapeutic targets. Gene therapy is being explored with vast potential for the treatment of HCM. EXPERT OPINION The armamentarium of therapeutic options for HCM is continuously increasing with the emergence of CMIs as mainstays of treatment. The future of HCM treatment is promising.
Collapse
Affiliation(s)
| | - Neil Garg
- Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | - Shiavax J Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | - Arjun Kanwal
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and Department of Medicine, New York Medical College, Valhalla, NY, USA
| | | |
Collapse
|
12
|
Tomasoni D, Adamo M, Metra M. February 2023 at a glance: focus on pathophysiology and treatment. Eur J Heart Fail 2023; 25:135-138. [PMID: 36823990 DOI: 10.1002/ejhf.2806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/22/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
13
|
Dominguez F, Cabrera E. Mavacamten in obstructive hypertrophic cardiomyopathy - Are beta-blockers blocking part of its shine? Eur J Heart Fail 2023; 25:271-273. [PMID: 36597820 DOI: 10.1002/ejhf.2768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Fernando Dominguez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Eva Cabrera
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Madrid, Madrid, Spain
| |
Collapse
|