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Long-Term Real-World Impact of Cardiac Myosin Inhibitors on Diastolic Function in Hypertrophic Cardiomyopathy

Aakash Bavishi1, John Fritzlen2, Marybeth Soutar3

  • 1Division of Cardiology, University of Illinois, Chicago, Illinois.

The American Journal of Cardiology
|April 24, 2026
PubMed

Insights

Long-term treatment with mavacamten significantly improved diastolic function in hypertrophic cardiomyopathy (HCM) patients. These positive effects on diastolic function, left atrial remodeling, and pulmonary pressures were durable over 24 months in a real-world setting.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Diastolic dysfunction is a primary driver of symptoms and adverse cardiac remodeling in hypertrophic cardiomyopathy (HCM).
  • Limited data exist on the long-term durability of diastolic improvements achieved with cardiac myosin inhibitor therapy in real-world clinical practice.

Purpose of the Study:

  • To evaluate the real-world durability of diastolic function improvements in patients with hypertrophic cardiomyopathy (HCM) treated with mavacamten for at least 18 months.
  • To assess changes in left ventricular (LV) structure, diastolic indices, and pulmonary pressures over a 24-month period.

Main Methods:

  • A real-world cohort study involving adults with HCM receiving mavacamten therapy for a minimum of 18 months.
  • Serial echocardiographic assessments were conducted at approximately 3-month intervals up to 24 months.
  • Analysis included paired baseline and end-point measurements of LV structure, diastolic function (e.g., e', E/e'), left atrial volume index (LAVI), and right ventricular systolic pressure (RVSP).

Main Results:

  • Significant reductions in LAVI (Δ -12.0 mL/m²), LV wall thickness (Δ -3.5 mm), and LV mass index (Δ -23.4 g/m²) were observed by 24 months (all p<0.001).
  • Improvements in diastolic function were evidenced by increased lateral e' (p<0.001) and medial e' (p<0.001), and decreased lateral E/e' (p<0.001) and medial E/e' (p<0.001).
  • A significant decrease in RVSP (p=0.01) and a shift toward lower grades of diastolic dysfunction were noted over the study period.

Conclusions:

  • Mavacamten treatment in a real-world HCM cohort led to significant improvements in echocardiographic measures of diastolic function.
  • These improvements in diastolic function, left atrial remodeling, and pulmonary pressures were sustained and durable through 24 months.
  • The findings support the long-term efficacy of mavacamten in managing diastolic dysfunction in HCM patients outside of clinical trial settings.

Keywords:
echocardiographyhypertrophic cardiomyopathyscreening

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