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Effect of Cardiac Myosin Inhibitors on Echocardiographic Features of Cardiac Structure and Function in Hypertrophic
Yang Lu1, Yuanyuan Zhu1, Zhuang Tian1,2
1Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China.
Insights
Cardiac myosin inhibitors (CMIs) significantly improve cardiac structure and diastolic function in hypertrophic cardiomyopathy (HCM) patients. However, their effect on left ventricular ejection fraction and atrial arrhythmia risk requires further investigation.
Area of Science:
- Cardiology
- Pharmacology
- Medical Research
Background:
- Novel cardiac myosin inhibitors (CMIs) show promise for treating hypertrophic cardiomyopathy (HCM).
- Understanding CMIs' impact on cardiac structure and function is crucial for HCM management.
Purpose of the Study:
- To meta-analyze the effects of CMIs on echocardiographic cardiac structure and function in HCM patients.
- To consolidate current evidence on CMI efficacy in improving HCM echocardiographic parameters.
Main Methods:
- Systematic literature search of PubMed, Cochrane Library, and Embase databases.
- Inclusion of 10 studies (5 RCTs, 3 RCT sub-studies, 2 cohort studies) involving 938 patients.
- Meta-analysis of echocardiographic data to assess CMI impact on cardiac parameters.
Main Results:
- CMIs significantly reduced interventricular septum thickness and left ventricular mass index.
- A significant reduction in left ventricular ejection fraction was observed with CMI use.
- CMIs improved diastolic function markers, including left atrial volume index and septal E/e' ratio.
- No significant association found between CMIs and atrial arrhythmia risk.
Conclusions:
- CMIs effectively enhance left ventricular structure and diastolic function in HCM.
- CMIs may reduce left ventricular ejection fraction, warranting further monitoring.
- The effect of CMIs on atrial arrhythmia risk remains inconclusive and requires additional research.
Background:
Recent advancements have introduced novel cardiac myosin inhibitors (CMIs) that have demonstrated significant efficacy in treating hypertrophic cardiomyopathy (HCM). This meta-analysis aimed to clarify the current understanding of the impact of CMIs on echocardiographic cardiac structure and function in patients with HCM.
Methods:
A comprehensive search of the PubMed, Cochrane Library, and Embase databases was conducted from inception until September 14, 2025. The studies reporting the impact of CMIs on echocardiographic cardiac structure and function in HCM patients were included.
Results:
Ultimately, this meta-analysis included 10 studies: five randomized controlled trials (RCTs), three echocardiographic sub-studies derived from RCTs, and two long-term cohort studies. A total of 938 patients were enrolled in these studies. This meta-analysis revealed that CMIs significantly reduce interventricular septum thickness (mean difference (MD): -1.77, 95% confidence interval (CI): -3.30 to -0.23; p = 0.0240). CMIs were also shown to significantly reduce left ventricular mass index (MD: -18.15, 95% CI: -32.65 to -3.65; p = 0.0141). Moreover, the pooled results demonstrated that administering CMIs can significantly reduce left ventricular ejection fraction (MD: -3.22, 95% CI: -5.60 to -0.85; p = 0.0078). CMIs also significantly improved echocardiographic parameters of left ventricular diastolic function, such as the left atrial volume index (MD: -5.75, 95% CI: -7.87 to -3.64; p < 0.0001) and septal E/e' ratio (MD: -3.80, 95% CI: -4.74 to -2.87; p < 0.0001). However, the results did not reveal an association between CMIs and the risk of atrial arrhythmias (risk ratio (RR): 0.98, 95% CI: 0.33 to 2.94; p = 0.9689).
Conclusions:
CMIs have shown great efficacy in improving left ventricular structure and diastolic function in HCM patients. Additionally, CMIs can reduce left ventricular ejection fraction. However, the impact of CMIs on the risk of atrial arrhythmias remains unclear.
The Prospero Registration:
CRD420251243904, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251243904.
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