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Mavacamten's Dose-Time Dynamics and Predictive Factors in Hypertrophic Obstructive Cardiomyopathy Cardiac Remodeling

Binbin Cao1, Yuanhong Li2, Xiaomin Chen1

  • 1Department of Cardiology, The First Affiliated Hospital of Ningbo University., Ningbo, China.

Echocardiography (Mount Kisco, N.Y.)
|July 16, 2026
PubMed

Insights

Clinically guided mavacamten therapy significantly reduced left ventricular outflow tract gradients and BNP levels in hypertrophic obstructive cardiomyopathy (HOCM) patients. Left ventricular ejection fraction was preserved, supporting individualized dosing with echocardiographic monitoring.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Imaging

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) presents significant challenges due to dynamic left ventricular outflow tract (LVOT) obstruction and disabling symptoms.
  • Many HOCM patients exhibit poor response to conventional pharmacotherapies.
  • Mavacamten, a novel cardiac myosin inhibitor, shows promise in improving LVOT gradients, but its real-world dose-response profile requires further elucidation.

Purpose of the Study:

  • To assess longitudinal changes in echocardiographic parameters, biomarkers, and safety profiles in symptomatic HOCM patients treated with clinically guided mavacamten.
  • To compare these outcomes against conventional pharmacotherapy in a real-world clinical setting.

Main Methods:

  • A single-center, prospective comparative cohort study involving 95 symptomatic HOCM patients (48 mavacamten, 47 conventional therapy).
  • Mavacamten initiated at 2.5 mg/day, titrated based on resting LVOT gradient (LVOTG) and ejection fraction (LVEF) up to 10 mg/day.
  • Longitudinal assessments at baseline, 3, 6, and 9 months; analysis of observed mean changes and inverse probability weighting for baseline imbalances.

Main Results:

  • Mavacamten group demonstrated a significant reduction in resting LVOTG, while the control group remained stable.
  • Brain natriuretic peptide (BNP) levels decreased significantly in the mavacamten group but not in the control group.
  • The predefined LVOTG response endpoint (≥30 mmHg reduction) was achieved by 18.8% of mavacamten patients versus 2.4% of controls (p=0.0175).

Conclusions:

  • Clinically guided mavacamten therapy effectively reduces LVOT gradients and BNP levels in symptomatic HOCM patients with preserved LVEF during short-term follow-up.
  • Findings support individualized mavacamten dosing strategies guided by echocardiographic monitoring.
  • Caution is advised in interpreting subgroup analyses due to limited sample sizes.
Abstract

Keywords:
dose–response relationshipechocardiographyhypertrophic obstructive cardiomyopathyindividualized therapymavacamten

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