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Impact of Mavacamten on Left Atrial Remodeling in Obstructive Hypertrophic Cardiomyopathy: Data From 3 Portuguese Centers
Session:
Sessão de Comunicações Orais 14 – Mavacamten na MCH obstrutiva: preditores de resposta, remodelagem e dados de vida real
Speaker:
Inês Pereira De Miranda
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Inês Pereira de Miranda; Julien Lopes; Débora Correia; Filipa Gerardo; Rodrigo Brandão; Sérgio Maltês; José Viegas; Tânia Laranjeira; Sílvia Aguiar Rosa; Bruno Rocha; João Bicho Augusto
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Background: </span></strong><span style="font-family:"Calibri",sans-serif">Left atrial (LA) remodeling is a key marker of diastolic burden and arrhythmic risk in hypertrophic cardiomyopathy (HCM). Mavacamten has been shown to reduce left ventricular outflow tract (LVOT) obstruction and improve filling pressures, but real-world data on its impact on LA structure and function remain limited.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Objective:</span></strong><span style="font-family:"Calibri",sans-serif"> To evaluate LA remodeling in patients with obstructive HCM treated with mavacamten across three Portuguese centers.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Methods:</span></strong> <span style="font-family:"Calibri",sans-serif">We conducted a multicenter observational study including consecutive patients with symptomatic obstructive HCM treated with mavacamten. Clinical data, laboratory parameters, ECG, cardiopulmonary exercise testing, and comprehensive echocardiography were collected at baseline, 4, 8 and 12 weeks, and at individually defined optimal dosing. Echocardiographic analysis focused on LA remodeling and diastolic burden, including LA diameter (LAD), </span></span><span style="font-family:"Calibri",sans-serif">indexed LA volume</span><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"> and E/e′ ratio. Paired comparisons across timepoints were performed with appropriate parametric tests, and effect sizes (Cohen’s d) and 95% confidence intervals (CI) were calculated. LA enlargement was defined as LAD ≥ 40 mm – changes in its prevalence were tested with the McNemar’s test.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Eighty-three patients were included (mean age 65 ± 12 years; 68.7% female). LAD showed no significant change at 12 weeks (44.2 ± 6.6 vs 43.2 ± 6.2 mm; mean change -1.0 mm, 95% CI 2.1 to 0.2; p = 0.11). At optimal dosing, however, LA structural reverse remodeling became evident: LAD decreased from 44.8 ± 6.0 to 41.2 ± 6.0 mm (mean change -3.7 mm, 95% CI -5.3 to -2.0; p < 0.001; Cohen’s d = 0.66). The prevalence of LA enlargement reduced from 79.1% to 55.8% (p = 0.013, McNemar). Similarly, E/e′ ratio decreased from 16.6 ± 6.3 to 13.7 ± 5.4 at 12 weeks (mean change -2.9; 95% CI -4.3 to -1.6; p < 0.001; d = 0.66) and further to 10.6 ± 3.6 at optimal dose (mean change -4.3; 95% CI -5.7 to -2.8; p < 0.001; d ≈ 1.0). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusion</span></strong><span style="font-family:"Calibri",sans-serif">: Mavacamten was associated with LA reverse remodeling, reflected by reductions in LA size and filling pressures, indicating effective and sustained atrial unloading. Given the central role of LA in HCM, these real-world findings suggest a potential atrial disease-modifying effect of mavacamten, supporting further evaluation of its impact on atrial fibrillation susceptibility and arrhythmic risk.</span></span></span></p>
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