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Mavacamten in Adults with Symptomatic Obstructive HCM Suitable for Septal Reduction Therapy – VALOR-HCMTürk Kardiyoloji Derneği Genç Kardiyologlar Bülteni - Mavacamten in Adults with Symptomatic Obstructive HCM Suitable for Septal Reduction Therapy – VALOR-HCM (Dr. Çağdaş Arslan)Reviewer: Dr. Çağdaş Arslan
Study: Mavacamten in Adults with Symptomatic Obstructive HCM Suitable for Septal Reduction Therapy – VALOR-HCM
Published congress: ACC 2022
Introduction
HCMP is a myocardial disease characterized by myocardial hypercontractility, dynamic LVOT obstruction, and impairment in diastolic parameters. Current pharmacological treatments are limited to some agents which used to reduce patients symptoms. In addition, invasive interventions such as septal alcohol ablation and myectmoy are available to correct the pathophysiology. There is a need for pharmacological agents to target the pathophysiology of the disease in the treatment of HCMP.
Objective
Mavacemten is an allosteric myosin inhibitor that reduces actin-myosin coupling and decreases cardiac contractility. The VALOR-HCM study compared mavacemten therapy with septal corrective therapies (septal alcohol ablation and myectomy) in HOCMP patients under maximal medical therapy.
Method
Eligible patients were randomized 1:1 to mavacemtan (n=56) and placebo (n=56). Mavacemtan was started with 5 mg and was titrated and patients were followed for 16 weeks.
Results and Statistics
The primary outcome was septal invasive treatment within or at the end of 16 weeks, or an indication for septal invasive treatment according to the guidelines at the end of 16 weeks, compared to 17.9% in the mavacamten arm of the study and 76.8% in the placebo arm (p < 0.0001). ? 1 point improvement in NYHA class (63% vs 21%, p<0.05), significantly decreasing a resting LVOT gradient (14 vs 46 mmHg, p<0.05) or LVOT gradient with valsalva (28 vs 78) mmHg, p<0.05) or Kansas Cardiomyopathy Questionnaire 23 score (80 vs 67 , p<0.05) were found in the mavacemten arm at 16 weeks.
Conclusion
According to the results of this study, mavacemtan improves symptoms and reduces the need for septal reduction therapy in patients with symptomatic HOCM.
Comments
These results are complementary to the EXPLORER-HCM results, which were the predecessors of this study. However, although no safety issues were observed during the study, a 16-week follow-up period remains confusing in terms of long-term complications. Also EXPLORER -LTE trial's 48 and 84 weeks follow up results were announced in ACC 22. In the study participants, improvement in the above criteria was observed without any additional complications.
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