Heart failure & cardiomyopathiesSecondary analysis
Exercise Performance With Aficamten vs Metoprolol in Obstructive Hypertrophic Cardiomyopathy
- Secondary analysis of the MAPLE-HCM randomised trial
- prespecified
- phase 3
- active-control
- 71 sites
Authors' conclusion
This prespecified analysis of MAPLE-HCM demonstrated monotherapy with aficamten was superior to metoprolol in promoting adaptation to multiple phases of exercise in patients with symptomatic oHCM
Study context
- Population
- Symptomatic obstructive HCM with exercise intolerance (pVO2 <100% of predicted), no AF history165 with validated tests
- Participants
- 175 participants
- Comparison
- Aficamten vs metoprolol
- Primary endpoint
- Submaximal exercise ventilation (VE)/VCO2 slope and anaerobic threshold; peak exercise duration, workload, heart rate and heart rate reserve; postexercise oxygen recovery rates; composite variables such as circulatory power
- Follow-up
- 24 weeks
Primary result
As reported in the abstract
week 24
Aficamten vs MetoprololDifference (95% CI)P value
VE/VCO2 slope
−2.8(−4.0 to −1.5)
P < 0.001Aficamten vs MetoprololDifference, mL/min (95% CI)P value
anaerobic threshold
76(41–111)
P < 0.001Aficamten vs MetoprololDifference, watts (95% CI)P value
peak workload
8(3–13)
P = 0.003Aficamten vs MetoprololDifference, seconds (95% CI)P value
time for VO2 to recover by 12.5% postexercise
−11(−16 to −5)
P < 0.001Aficamten vs MetoprololDifference, mm Hg × mL/min per kg (95% CI)P value
circulatory power
819(569–1070)
P < 0.001Further findings
| Outcome | Aficamten | Metoprolol | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Large improvement in peak VO2 (≥3.0 mL/kg/min) | 20.5% | 3.7% | 6.8 (2.0–22.5) | P < 0.001 | |
| 0.050.21520Odds ratio (log scale) |
Large reduction in peak VO2 (≥3.0 mL/kg/min)
OR 10.6 (2.6 to ∞) · P < 0.001
Original publication
Exercise Performance With Aficamten vs Metoprolol in Obstructive Hypertrophic Cardiomyopathy. JAMA Cardiol. Published 1 August 2026. doi:10.1001/jamacardio.2026.1730
Summarised from the published abstract; every number is checked against it