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Heart failure & cardiomyopathiesSecondary analysis

Impact of Aficamten on Echocardiographic Cardiac Structure and Function in Symptomatic Obstructive Hypertrophic Cardiomyopathy

J Am Coll CardiolPublished

  • Secondary analysis of the SEQUOIA-HCM randomised trial
  • phase 3
  • multicenter
  • double-blinded
  • placebo-controlled
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Authors' conclusion

Compared with placebo, patients receiving aficamten demonstrated significant improvement in LVOT gradients and measures of LV diastolic function, and several of these measures were associated with improvements in pVO2, KCCQ-CSS, and NT-proBNP. A modest decrease in LVEF occurred yet remained within normal range.

Study context

Population
Adults with symptomatic obstructive hypertrophic cardiomyopathy (oHCM)
Participants
282 adults
Comparison
Aficamten vs placebo
Primary endpoint
Echocardiographic measures of cardiac structure and function
Follow-up
24 weeks

Primary result

As reported in the abstract

Echocardiographic structure and function

Aficamten significantly lowered resting and Valsalva left ventricular outflow (LVOT) gradients and improved left atrial volume index, lateral and septal e' velocities, and lateral and septal E/e'

all P ≤ 0.001

LV end-systolic volume increased and wall thickness decreased

all P ≤ 0.003

Further findings

Association of echocardiographic changes with pVO2, NT-proBNP and Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores (KCCQ-CSS) (aficamten-treated)

Improved pVO2 and NT-proBNP reduction associated with improvement in lateral e' and septal and lateral E/e'
all P < 0.03
KCCQ-CSS improvement associated with decrease in both LVOT gradients
all P < 0.001

Safety

Outcomedifference (%) (95% CI)P value
LVEF (mild reversible decrease) · 24 weeks−4.8 (−6.4% to −3.3%)P < 0.001
Outcomedifference (%) (95% CI)P value
Absolute LV global circumferential strain · 24 weeks−3.7 (1.8%–5.6%)P < 0.0010

Original publication

Impact of Aficamten on Echocardiographic Cardiac Structure and Function in Symptomatic Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol. Published 1 September 2024. doi:10.1016/j.jacc.2024.08.002
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Summarised from the published abstract; every number is checked against it