{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:11:25Z","timestamp":1789726285913,"version":"4.0.1"},"reference-count":35,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:00:00Z","timestamp":1740182400000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,2,11]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Unlike other suggested therapies, myosin inhibitors have been shown to change the course of hypertrophic cardiomyopathy by altering the contractile mechanics of cardiomyocytes. This meta-analysis sought to determine the efficacy of mavacamten and aficamten in hypertrophic cardiomyopathy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The online databases were searched from inception to July 2024, including the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, ClinicalTrials.gov. The meta-analytical data were pooled using risk ratios (RRs) with 95%\u2009CI, standard mean difference (SMD) and SE.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 6 randomised controlled trials with 826 hypertrophic cardiomyopathy patients (mean age\u00b1SD up to 59.8\u00b114.2 years in intervention vs 60.9\u00b110.5 years in placebo) were included in our study. Of these, 443 received a cardiac myosin inhibitor and 383 received a placebo. The resting left ventricular outflow tract (LVOT) gradient between the two groups was considerably improved by cardiac myosin inhibitors (MD \u221257.27; 95%\u2009CI \u221263.05 to \u221251.49). Significant differences were also observed in the post-Valsalva LVOT gradient between the two groups (MD \u221255.86; 95%\u2009CI \u221265.55 to \u221246.18). Significantly decreased left ventricle ejection fraction (LVEF) was also seen (MD \u22124.74; 95%\u2009CI \u22127.22 to \u22122.26). The New York Health Association (NYHA) class improvement between the two groups also changed significantly (RR 2.21; 95%\u2009CI 1.75 to 2.80). Cardiac myosin inhibitors also caused significant improvement in the Kansas City Cardiomyopathy Questionnaire in a Clinical Summary Score between the two groups (MD 7.71; 95%\u2009CI 5.37 to 10.05) and significant reduction in the N-terminal pro-B-type natriuretic peptide (SMD \u221213.27; 95%\u2009CI \u221217.51 to \u22129.03) and the cardiac troponin I (SMD \u221211.90; 95%\u2009CI \u221215.07 to \u22128.72).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>According to our meta-analysis, cardiac myosin inhibitors significantly improve the resting and post-Valsalva LVOT gradient, reduce the LVEF and improve the NYHA class and cardiac biomarkers when compared with the placebo.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD52024586161.<\/jats:p>\n               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Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bisma","family":"Akram","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momina","family":"Maham","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masooma Zainab","family":"Bokhari","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleena","family":"Akram","sequence":"additional","affiliation":[{"name":"Department of Medicine, Shalamar Medical and Dental College, Lahore, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sania","family":"Akram","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furqan","family":"Yaqub","sequence":"additional","affiliation":[{"name":"Department of Cardiology, King Edward Medical University, Lahore, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,23]]},"reference":[{"key":"2025081710063543000_12.1.e003215.1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(12)60397-3"},{"key":"2025081710063543000_12.1.e003215.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.10.1308"},{"key":"2025081710063543000_12.1.e003215.3","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.acvd.2022.06.003","article-title":"Medical treatment of patients with hypertrophic 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Abstract 15493: The Efficacy of Cardiac Myosin Inhibitors versus Placebo in Patients With Symptomatic Hypertrophic Cardiomyopathy. 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