Can mavacamten be considered for patients with HCM and ongoing dyspnea in setting of an elevated LVEDP but without significant LV outflow obstruction on imaging?

Yes, mavacamten may be a viable option for patients with HCM who have persistent dyspnea and elevated LVEDP, even without significant LVOT obstruction. While most of the evidence for mavacamten focuses on obstructive HCM, emerging data suggest it may have a role in non-obstructive HCM as well.

The MAVERICK-HCM trial specifically evaluated mavacamten in non-obstructive HCM and showed reductions in myocardial stress biomarkers such as NT-proBNP and troponin I, which are closely linked to diastolic dysfunction and elevated LVEDP. These findings suggest that mavacamten may improve myocardial relaxation and compliance in this patient population.

Insights from the PIONEER-HCM, EXPLORER-HCM, and VALOR-HCM trials, though focused on obstructive HCM, f...