Heart failure & cardiomyopathiesSecondary analysis
Effect of Aficamten on Cardiac Structure and Function in Patients with Symptomatic Nonobstructive Hypertrophic Cardiomyopathy
- Secondary analysis of the ACACIA-HCM randomised trial
- prespecified exploratory analysis
- placebo-controlled
- phase 3
- 1:1 randomisation
Authors' conclusion
In patients with nonobstructive hypertrophic cardiomyopathy, aficamten improved echocardiographic measures of diastolic function.
Study context
- Population
- Symptomatic patients with nonobstructive hypertrophic cardiomyopathy
- Participants
- 517 patients
- Comparison
- Aficamten vs placebo
- Primary endpoint
- Echocardiographic measures (adjusted for baseline values, intracavity obstruction and baseline AF)
- Follow-up
- 36 weeks
Primary result
As reported in the abstract
Echocardiographic measures (prespecified exploratory analysis)
Aficamten vs PlaceboDifference, % (CI)P value
LVEF decreased
−4.6(−5.5 to −3.6)
P < 0.001Aficamten vs PlaceboDifference, cm/s (CI)P value
lateral e' velocity
0.9(0.6–1.2)
P < 0.001septal e' velocity
0.7(0.4–0.9)
P < 0.001- Peak tricuspid regurgitation velocity improved
- −10.4 cm/s [−19.9, −1.0]; P=0.030
- Left atrial volume index did not significantly improve
- −1.3 [95% CI, −2.6, 0.04]; P=0.06
Further findings
| Outcome | difference (cm/s) (CI) | P value | |
|---|---|---|---|
| Echocardiographic measures at end of treatment · up to 72 weeks (end of treatment) — Aficamten vs Placebo · lateral e' velocity | 0.9 (0.5–1.2) | P < 0.001 | |
| Echocardiographic measures at end of treatment · up to 72 weeks (end of treatment) — Aficamten vs Placebo · septal e' velocity | 0.9 (0.6–1.1) | P < 0.001 | |
| −0.500.511.5Difference, cm/s (linear scale) |
| Outcome | difference (CI) | P value | |
|---|---|---|---|
| Echocardiographic measures at end of treatment · up to 72 weeks (end of treatment) — Aficamten vs Placebo · septal E/e' | −1.4 (−2.1 to −0.6) | P < 0.001 | |
| −3−2−101Difference (linear scale) |
- Echocardiographic measures at end of treatment — Left atrial volume index: trend towards improvement with longer treatment exposure
- −1.7 [−3.2, −0.3]; P=0.022
Echocardiographic measures at end of treatment · up to 72 weeks (end of treatment)
- Peak tricuspid regurgitation velocity: sustained effect through end of treatment
Dose response
- Incremental improvements in LV structure and function vs placebo as doses increased; diastolic improvement evident by week 2 of titration
Original publication
Effect of Aficamten on Cardiac Structure and Function in Patients with Symptomatic Nonobstructive Hypertrophic Cardiomyopathy. Circulation. Published 29 August 2026. doi:10.1161/circulationaha.126.082343
Summarised from the published abstract; every number is checked against it