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Cardiac MRI characterization of ventricular remodeling during Mavacamten treatment: a multicentric study
Session:
Sessão de Comunicações Orais 14 – Mavacamten na MCH obstrutiva: preditores de resposta, remodelagem e dados de vida real
Speaker:
Julien Lopes
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.3 Myocardial Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Julien Lopes; Débora Correia; Inês Pereira de Miranda; Isabel Cardoso; Vera Ferreira; José Miguel Viegas; Pedro Garcia Brás; Inês Grácio Almeida; Bruno Rocha; João Bicho Augusto; Rui Cruz Ferreira; Sílvia Aguiar Rosa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Mavacamten, a cardiac myosin inhibitor, effectively reduces left ventricular outflow tract (LVOT) gradients by lowering myocardial contractility and is approved for the treatment of obstructive hypertrophic cardiomyopathy (oHCM). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Aim:</strong> To evaluate the impact of mavacamten treatment on myocardial structural remodeling and ventricular functional parameters assessed by cardiac magnetic resonance (CMR).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We performed a prospective, multicenter, observational study including patients with oHCM who initiated mavacamten therapy and underwent CMR imaging at baseline and after six months of treatment. CMR parameters were collected,<u><span style="color:teal"> </span></u>including<u><span style="color:teal">:</span></u> left and right ventricular index volumes and ejection fraction, stroke volume index (SVi), indexed LV mass (iLV mass), maximum wall thickness (MWT), native T1 mapping, LV late gadolinium enhancement (LV LGE) percentage, and myocardial deformation assessed by ventricular feature tracking strain (longitudinal, circumferential, and radial). Changes in CMR measurements between baseline and follow-up (FU) were analysed using paired t-tests. In addition, strain parameters were compared between patients who experienced a significant reduction in LVEF (>10%) and the remaining patients using independent t-tests.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">27 patients were included, with a median age of 67.0 [IQR 58 – 75], 44.4% male. During FU, one patient permanently discontinued mavacamten due to a significant decline in LVEF. Regarding CMR parameters (Table 1), no statistically significant differences were observed regarding LVEDVi, RVEDVi and LV LGE percentage. There were significant increases in LVESVi and RVESVi and a significant decrease was observed in SVi, iLV mass, MWT, right and left ventricular ejection fractions and native T1 mapping values. Patients who experienced a significant reduction in LVEF at FU showed a consistent decline across all three strain categories - longitudinal circumferential, and radial. In contrast, patients without a significant reduction in LVEF showed a slight improvement in these strain parameters over follow-up.<u><span style="color:teal"> </span></u></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">In our cohort, treatment with mavacamten was associated with a reduction in LV mass, MWT and native T1 mapping values. Mild reduction in LVEF at 6-month FU was noted without impairment in ventricular strain. However, among patients with significant decline in LVEF, a parallel deterioration in all types of ventricular strain was observed.</span></span></p>
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