1b) Our expert (and returning @cardiomet_ce) author is Giuseppe Galati MD, MMSc in Heart Failure, FHFA, @GiuseppeGalati_ , Consultant #Cardiologist #HeartFailure & #Cardiomyopathies pic.twitter.com/W3CgRK0qAS
— cardio-met (@cardiomet_CE) January 17, 2023
3) This program is supported by an educational grant from Bristol-Myers Squibb. Statement of accreditation and author disclosures at https://t.co/NOg9ub8H2q. See prior #tweetorial in this series from @MasriAhmadMD, still available for credit, at https://t.co/1Ch6YqcN8k. pic.twitter.com/O5qMA0UcrC
— cardio-met (@cardiomet_CE) January 17, 2023
5) Although the natural history of #HCM is benignant in the majority of cases (~70-75% of patients), other patients can develop #SuddenCardiacDeath, #HeartFailure, #AtrialFibrillation and #Stroke and #InfectiveEndocarditis pic.twitter.com/iptVravWgy
— cardio-met (@cardiomet_CE) January 17, 2023
7) More than 2/3 of #HCM patients (~75%) have a #LVOTO at rest or during exercise and they are affected by #HOCM (#HypertrophicObstructiveCardiomyopathy). Less than 1/3 are affected by #HNOCM. pic.twitter.com/U0mB4WMYNN
— cardio-met (@cardiomet_CE) January 17, 2023
9) 2⃣ anatomic alterations in the MV including longer leaflets as well as anterior displacement of the papillary muscles & MV apparatus. #LVOTO in HCM is dynamic and sensitive to ventricular load and contractility. pic.twitter.com/sKkHKQ88X2
— cardio-met (@cardiomet_CE) January 17, 2023
11) The “historical” management endorsed by the last (2014) #ESCguidelines include general maneuvers (such as avoiding specific drugs) and 1st and 2nd line drugs, i.e.: beta-blocker, Ca2+-channels blockers, disopyramide alone or in combination. pic.twitter.com/Q2YuF4k4Ak
— cardio-met (@cardiomet_CE) January 17, 2023
13) Also the therapeutic algorithm endorsed by the American guidelines was very similar to that endorsed by the European guidelines and reflected no significant improvement until 2020 on the management of #HOCM. pic.twitter.com/whrtsXqVul
— cardio-met (@cardiomet_CE) January 17, 2023
15) Finally, #disopyramide (used as 2nd or 3rd line therapy often in association) has as main limitation anticholinergic side-effects e.g. dry eyes & mouth, urinary retention, & constipation. Moreover, #QTc prolongation is not rare & should be monitored during dose up-titration. pic.twitter.com/jrumfQaIf3
— cardio-met (@cardiomet_CE) January 17, 2023
17) Moreover, pharmacological tx can be poorly effective in ⬇️LVOTO, ➡️ #HOCM pts may need #septal_myectomy (SM) or alcohol septal ablation (ASA). A less effective option can be dual chamber pacing: AV sequential pacing w/short AV interval (100+30 ms) to⬆️ RV apex pre-excitation pic.twitter.com/XiYsUFfApY
— cardio-met (@cardiomet_CE) January 17, 2023
18b) Complications includes #AVblock, LBBB & more rarely Ventricular septal defects #VSD & aortic regurgitation. pic.twitter.com/GeabJDevgW
— cardio-met (@cardiomet_CE) January 17, 2023
20) #EndStage #HCM evolution (or “burn-out” or hypokinetic) can be a complication of these procedures (mainly of ASA when performed in less experienced centers). This is defined by #HCM w/ #LVEF≤50%, has ⬆️mortality & is characterized by extensive amount of #myocardial_fibrosis pic.twitter.com/c7Hm4LhPTO
— cardio-met (@cardiomet_CE) January 17, 2023
22) Here the recent recommendations from last AHA/ACC @American_Heart / @ACCinTouch Guidelines on #HCM. pic.twitter.com/tlPPOjfERb
— cardio-met (@cardiomet_CE) January 17, 2023
24a) So what have you learned? #HOCM has an established historical management encompassing both pharmacological & not pharmacological therapeutic options. pic.twitter.com/9SbFCtQUgH
— cardio-met (@cardiomet_CE) January 17, 2023
25) Enter your response & return TOMORROW for the correct answer & the remainder of this #accredited #tweetorial! 👍to @GoggleDocs @DrMarthaGulati @BiykemB @mmamas1973 @SABOURETCardio @iamritu @gcfmd @hvanspall @JJheart_doc @gbiondizoccai @ValleAlfonso
— cardio-met (@cardiomet_CE) January 17, 2023
26b) Yesterday's knowledge ✔️? Scroll back up to 25) & answer if you didn't already! The answer is D, both B & C. Both are effective but with limitations & there’s an unmet need for medical #HOCM management covered today by #macacamtem & perhaps in the future also by #aficamtem.
— cardio-met (@cardiomet_CE) January 18, 2023
27b) #EXPLORER_HCM is the phase 3 RCT on #mavacamtem in #HOCM pic.twitter.com/yXxIoLMmTf
— cardio-met (@cardiomet_CE) January 18, 2023
29) In #EXPLORER_HCM #mavacamtem was shown to significantly improve both Primary EPs (peak VO2 as determined by #CPET & an improvement of ≥ 1 NYHA class) & Secondary EPs (⬇️LVOT gradient,⬇️NYHA class,⬆️#QoL measured by #KCCQ). Moreover, it⬇️#NTproBNP & #hs_TnI pic.twitter.com/GscVyf7cvQ
— cardio-met (@cardiomet_CE) January 18, 2023
31) An #EXPLORER_HCM ECHO substudy showed beyond the significant reduction of #LVOTO (see above) a slight ⬇️ of #LVEF a ⬇️of ventricular hypertrophy & ⬆️of diastolic function. pic.twitter.com/RYEYa6WgQQ
— cardio-met (@cardiomet_CE) January 18, 2023
33) A health status analysis of #EXPLORER_HCM showed significant ⬆️ #QoL measured by #KCCQ with clinical improvement from moderate to large and to very large. These improvements started immediately after the start of the drug & lasted for all the observational follow-up (30 wks) pic.twitter.com/Q1xBOmhfpK
— cardio-met (@cardiomet_CE) January 18, 2023
35) In April 2022, based on these data, @US_FDA approved #mavacamtem in #NYHA II-III #HOCM to improve functional capacity & symptoms at a 5mg dose once daily with subsequent doses with titration (max 15mg OD). @EMA_News approval is expected soon. pic.twitter.com/2mm9APbiSv
— cardio-met (@cardiomet_CE) January 18, 2023
37) #VALOR_HCM demonstrated even more important result of #mavacamtem in #HOCM, Indeed it significantly reduced the need for #SeptalReductionTherapy. The previous benefits has been confirmed as the safety profile.
— cardio-met (@cardiomet_CE) January 18, 2023
👉 https://t.co/pFpnR7KX11 pic.twitter.com/jUw0xPjvsx
39) Recently another new drug #aficamtem showed significant benefits similar to that of #mavacamtem in a phase 2 RCT #REDWOOD_HCM. However, further confirmation will come from the ongoing Ph 3 RCT #SEQUOIA_HCM, which is enrolling 270 #HOCM pts. pic.twitter.com/LjrGUigbnm
— cardio-met (@cardiomet_CE) January 18, 2023
41) It's d, a & b. And now you have great insight 👁️into contemporary management of #HCM/#HOCM. Grab your 🆓CE/#CME at https://t.co/yM1Cxlin6k and stay tuned 📺to @cardiomet_ce for more expert-led education. ✔️out @ckd_ce too! I am @GiuseppeGalati_ and I 🙏for joining!
— cardio-met (@cardiomet_CE) January 18, 2023