Heart failure & cardiomyopathies
Real-World Candidacy to Mavacamten in a Contemporary Hypertrophic Obstructive Cardiomyopathy Population
Authors' conclusion
Real-world HOCM patients differ from the EXPLORER-HCM population for their older age, lower LVEF and larger atrial volume, potentially reflecting a more advanced stage of the disease. About half of real-world HOCM patients were found eligible to mavacamten.
Study context
- Population
- Hypertrophic obstructive cardiomyopathy (HOCM) patients with significant left ventricular outflow tract obstruction (LVOTO) (gradient ≥30 mmHg at rest or ≥50 mmHg after Valsalva or exercise), 25 Italian HCM outpatient clinics662 with persistent LVOTO
- Participants
- 1,706 patients
- Exposure
- Real-world HOCM patients with persistent LVOTO vs EXPLORER-HCM trial population
- Real-world HOCMn = 662
- Outcome
- Eligibility to mavacamten (EXPLORER-HCM enrolment criteria and European guidelines)
Methodological detailsmulticentre, 25 Italian HCM outpatient clinics
- Multicentre
- 25 Italian HCM outpatient clinics
Main finding
As reported in the abstract
Eligible for enrolment in EXPLORER-HCM
324
48.9%
Eligible for mavacamten per European guidelines
339
51.2%
Observational data: associations, not effects.
Further findings
Age · older in real-world HOCM
P = 0.02
BMI · lower in real-world HOCM
P < 0.0001
History of AF · more frequent in real-world HOCM
P = 0.027
Persistent LVOTO despite therapy
- LVOTO resolved by therapy
- 1044 (61.2%) of 1706
- Persistent LVOTO
- 662 (38.8%)
Left ventricular ejection fraction (LVEF) (echocardiography), real-world HOCM vs EXPLORER-HCM
- Lower LVEF in real-world HOCM vs EXPLORER-HCM
- 66 ± 7% vs. 74 ± 6%, p < 0.0001
Resting LVOT gradient (echocardiography), real-world HOCM vs EXPLORER-HCM
- Higher resting LVOT gradient in real-world HOCM vs EXPLORER-HCM
- 60 ± 27 vs. 52 ± 29 mmHg, p = 0.003
Left atrial volume index (echocardiography), real-world HOCM vs EXPLORER-HCM
- Larger LA volume index in real-world HOCM vs EXPLORER-HCM
- 49 ± 16 vs. 40 ± 12 ml/m² , p < 0.0001
Original publication
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