The association of aortic stenosis (AS) and obstructive hypertrophic cardiomyopathy raises questions about AS quantification, the management of left ventricular outflow tract obstruction, and AS treatment. Recently, mavacamten demonstrated its efficacy in reducing left ventricular outflow tract obstruction gradient. This case reports on mavacamten use in this challenging association.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328762PMC
http://dx.doi.org/10.1016/j.jaccas.2024.102430DOI Listing

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Considerations for drug trials in hypertrophic cardiomyopathy.

ESC Heart Fail

October 2024

Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.

Article Synopsis
  • Hypertrophic cardiomyopathy (HCM) is a diverse heart condition that can lead to severe health issues and traditionally managed through symptom relief and the use of defibrillators to prevent sudden cardiac death.
  • There is a recognized need for treatments that modify the disease itself, and recently, new therapies like mavacamten, a myosin inhibitor, have gained regulatory approval.
  • Clinical trials for HCM face unique challenges, which include selecting patients based on their genetic and symptom profiles, measuring outcomes effectively, and considering factors like trial duration and sample size when interpreting results.
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Nemaline myopathy (NM) is a genetic muscle disease, primarily caused by mutations in the NEB gene (NEB-NM) and with muscle myosin dysfunction as a major molecular pathogenic mechanism. Recently, we have observed that the myosin biochemical super-relaxed state was significantly impaired in NEB-NM, inducing an aberrant increase in ATP consumption and remodelling of the energy proteome in diseased muscle fibres. Because the small-molecule Mavacamten is known to promote the myosin super-relaxed state and reduce the ATP demand, we tested its potency in the context of NEB-NM.

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The association of aortic stenosis (AS) and obstructive hypertrophic cardiomyopathy raises questions about AS quantification, the management of left ventricular outflow tract obstruction, and AS treatment. Recently, mavacamten demonstrated its efficacy in reducing left ventricular outflow tract obstruction gradient. This case reports on mavacamten use in this challenging association.

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Purpose Of Review: There has been much debate surrounding novel medical therapies and heart transplantation listing challenges in patients with hypertrophic cardiomyopathy (HCM).

Recent Findings: Recent clinical trials led to FDA approval of mavacamten (a cardiac myosin inhibitor), offering symptom relief and potentially delaying/avoiding invasive septal reduction therapies for some patients with HCM and left ventricular outflow obstruction (LVOTO). For those with refractory symptoms and end-stage heart failure, heart transplantation remains the gold standard.

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