Standard of Care Medication Withdrawal in Patients With Obstructive Hypertrophic Cardiomyopathy Receiving Aficamten in FOREST-HCM

Author Robert W. Yeh, MD, FACC, and JACC Associate Editor Celina M. Yong, MD, FACC, discuss the results of the TARGET-IV NA trial. In the trial, 1720 patients with stable or acute coronary syndromes were randomized to undergo PCI with a BP-SES or any commonly used 2nd generation DES. At 12 months, BP-SES was non-inferior to control DES for the primary endpoint of Target Lesion Failure (cardiac death, target vessel-related myocardial infarction (MI), or ischemia-driven target lesion revascularization) which occurred in 3.4% of the BP-SES arm versus 3.3% in the control arm; p-value for non-inferiority. Secondary endpoints were also similar between groups.

In this episode of JACC, Author Suzanne Arnold, MD and JACC Associate Editor Dennis T. Ko, MD, discusses groundbreaking findings from the Tricatin-2 trial, the first clinical study on transcatheter tricuspid valve replacement. The results reveal significant improvements in quality of life for patients, particularly those with severe tricuspid regurgitation, highlighting the transformative potential of this procedure compared to traditional medical therapy.

Author Shao-Liang Chen, MD, FACC, and JACC Associate Editor Celina M. Yong, MD, FACC, discuss patients with simple and true coronary bifurcation lesions undergoing provisional stenting. Main vessel stenting with a DCB for the compromised side branch resulted in a lower 1-year rate of the composite outcome compared with an NCB intervention for the side branch. The high rates of periprocedural myocardial infarction, which occurred early and did not lead to revascularization, are of unclear clinical significance.

Author Nicolas M. Van Mieghem, MD, PhD, FACC, and JACC: Executive Associate Editor Aakriti Gupta, MD, FACC,  discuss the TAVR UNLOAD trial, which focused on patients with moderate aortic stenosis (AS) and reduced ejection fraction (HFrEF). The trial found no significant difference in the primary endpoint (composite of mortality, stroke, and hospitalizations) between the TAVR and clinical surveillance groups. However, patients who underwent TAVR showed a significant improvement in quality of life at one year. The conversation highlighted the need for individualized treatment approaches, emphasizing patient selection, while also considering trial limitations, including slow enrollment and study size.

In the November 5, 2024 issue of JACC, Dr. Valentin Fuster summarizes the November 5, 2024 issue of the JACC, which focuses exclusively on hypertrophic cardiomyopathy (HCM). Highlighting six original research papers, the discussion emphasizes the groundbreaking impact of the cardiac myosin inhibitor Aficamten on health outcomes, symptom burden, and cardiac structure in patients with obstructive HCM, while also exploring genetic screening implications for affected families.

In this episode, Dr. Valentin Fuster delves into the latest research on hypertrophic cardiomyopathy, highlighting the significant health status improvements achieved with the new cardiac myosin inhibitor, Aficamten, compared to placebo. The findings from the Sequoia HCM study reveal that Aficamten markedly enhances patients' quality of life and alleviates symptoms like chest pain and shortness of breath, paving the way for more effective treatments in this challenging condition.

In this episode, Dr. Valentin Fuster explores groundbreaking research on hypertrophic cardiomyopathy, focusing on the effects of the drug aficamten on cardiac structure and function. Highlighting significant findings from the Sequoia HCM trial, the discussion underscores the potential of aficamten to induce favorable cardiac remodeling and improve patient outcomes, signaling a transformative era in the management of this condition.

In this episode, Dr. Valentin Fuster delves into a groundbreaking study on the effects of the cardiac myosin inhibitor, Aficamten, on patients with obstructive hypertrophic cardiomyopathy. The findings reveal significant improvements in echocardiographic measures of cardiac function, despite a mild and reversible decrease in left ventricular ejection fraction, highlighting the need for long-term safety evaluations of this promising treatment.

In this episode, Dr. Valentin Fuster introduces a dedicated focus on hypertrophic cardiomyopathy, featuring a pivotal study by Dr. Martin Maron and Dr. lacopo Olivotto on the impact of aficamptin. This pre-specified sub-analysis from the SEQUOIA HCM trial aims to comprehensively evaluate the drug's effects on various aspects of disease burden, enhancing our understanding of its clinical efficacy.

In this episode, Dr. Valentin Fuster highlights the Forest HCM study, which focuses on the withdrawal of standard care medications in patients with obstructive hypertrophic cardiomyopathy receiving afficantin. The study shows promising results: nearly half of the patients who attempted to reduce or stop their medications did so successfully, with significant improvements in functional class and symptoms. While the findings suggest that afficantin may allow for the reduction of traditional therapies, caution is advised, as not all patients may benefit equally.