{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T19:46:02Z","timestamp":1776109562302,"version":"3.50.1"},"reference-count":48,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hypertrophic cardiomyopathy (HCM) is a genetic disease characterized by an increased left ventricular wall thickness in the absence of increased afterload conditions. In addition to diastolic dysfunction, obstruction of the left ventricular outflow tract is common in HCM and has an important influence on symptoms and outcome. Over the last five decades or two decades, respectively, surgical myectomy and alcohol septal ablation were the only therapeutic options if standard medical care was not sufficient. Recently, a new option has become available that has the potential to revolutionize the therapeutic strategies for patients with HCM. Mavacamten is a myosin inhibitor that belongs to a completely new drug class and targets the excessive actin\u2013myosin cross-bridging that is the underlying pathology of HCM. By reducing the actin\u2013myosin interactions, mavacamten not only reduces the left ventricular outflow tract (LVOT) obstruction but also seems to have positive effects on the diastolic function, microcirculation, and cardiac structure. This article summarizes the current evidence on alcohol septal ablation and reviews the preclinical and clinical data on mavacamten for the treatment of patients with obstructive HCM.<\/jats:p>","DOI":"10.3390\/jcm12206628","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T11:46:26Z","timestamp":1697715986000},"page":"6628","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Alcohol Septal Ablation or Mavacamten for Obstructive Hypertrophic Cardiomyopathy"],"prefix":"10.3390","volume":"12","author":[{"given":"Smita","family":"Scholtz","sequence":"first","affiliation":[{"name":"Klinik f\u00fcr Allgemeine und Interventionelle Kardiologie\/Angiologie, Herz und Diabeteszentrum NRW, Ruhr-Universit\u00e4t Bochum, 32545 Bad Oeynhausen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Volker","family":"Rudolph","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemeine und Interventionelle Kardiologie\/Angiologie, Herz und Diabeteszentrum NRW, Ruhr-Universit\u00e4t Bochum, 32545 Bad Oeynhausen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan-Christian","family":"Reil","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemeine und Interventionelle Kardiologie\/Angiologie, Herz und Diabeteszentrum NRW, Ruhr-Universit\u00e4t Bochum, 32545 Bad Oeynhausen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.1161\/01.CIR.0000066323.15244.54","article-title":"Hypertrophic Cardiomyopathy: Distribution of Disease Genes, Spectrum of Mutations, and Implications for a Molecular Diagnosis Strategy","volume":"107","author":"Richard","year":"2003","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ejmg.2010.07.007","article-title":"Prevalence and Spectrum of Mutations in a Cohort of 192 Unrelated Patients with Hypertrophic Cardiomyopathy","volume":"53","author":"Millat","year":"2010","journal-title":"Eur. J. Med. Genet."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1161\/01.CIR.92.4.785","article-title":"Prevalence of Hypertrophic Cardiomyopathy in a General Population of Young Adults","volume":"92","author":"Maron","year":"1995","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.amjmed.2003.05.009","article-title":"Prevalence of Idiopathic Hypertrophic Cardiomyopathy in China: A Population-Based Echocardiographic Analysis of 8080 Adults","volume":"116","author":"Zou","year":"2004","journal-title":"Am. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1016\/S0735-1097(99)00039-X","article-title":"Clinical Profile of Hypertrophic Cardiomyopathy Identified De Novo in Rural Communities 1","volume":"33","author":"Maron","year":"1999","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1016\/j.jacc.2015.01.019","article-title":"New Perspectives on the Prevalence of Hypertrophic Cardiomyopathy","volume":"65","author":"Semsarian","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1161\/CIRCULATIONAHA.106.644682","article-title":"Hypertrophic Cardiomyopathy Is Predominantly a Disease of Left Ventricular Outflow Tract Obstruction","volume":"114","author":"Maron","year":"2006","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1056\/NEJMoa021332","article-title":"Effect of Left Ventricular Outflow Tract Obstruction on Clinical Outcome in Hypertrophic Cardiomyopathy","volume":"348","author":"Maron","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1016\/j.jacc.2020.08.045","article-title":"2020 AHA\/ACC Guideline for the Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy","volume":"76","author":"Ommen","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","unstructured":"Protonotarios, A., Gimeno, J.R., Barriales-Villa, R., Basso, C., Bezzina, C.R., Biagini, E., Blom, N.A., de Boer, R.A., Haugaa, K.H., and Ingles, J. (2023). 2023 ESC Guidelines for the management of cardiomyopathies: Developed by the task force on the management of cardiomyopathies of the European Society of Cardiology (ESC). Eur. Heart J., ehad194."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2733","DOI":"10.1093\/eurheartj\/ehu284","article-title":"2014 ESC Guidelines on Diagnosis and Management of Hypertrophic Cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC)","volume":"35","author":"Elliott","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/00000658-196108000-00003","article-title":"Surgical Treatment of Idiopathic Hypertrophic Subaortic Stenosis: Technic and Hemodynamic Results of Subaortic Ventriculotomy","volume":"154","author":"Morrow","year":"1961","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/0003-4975(94)92268-3","article-title":"Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy","volume":"58","author":"Messmer","year":"1994","journal-title":"Ann. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1161\/01.CIR.92.9.122","article-title":"Long-term Clinical and Echocardiographic Follow-up After Surgical Correction of Hypertrophic Obstructive Cardiomyopathy with Extended Myectomy and Reconstruction of the Subvalvular Mitral Apparatus","volume":"92","author":"Schoendube","year":"1995","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.surg.2023.04.028","article-title":"Volume-Outcome Relationship in Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy","volume":"174","author":"Hadaya","year":"2023","journal-title":"Surgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1002\/ccd.26293","article-title":"A Meta Analysis of Current Status of Alcohol Septal Ablation and Surgical Myectomy for Obstructive Hypertrophic Cardiomyopathy","volume":"88","author":"Singh","year":"2016","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/clc.23113","article-title":"Alcohol Septal Ablation vs Myectomy for Symptomatic Hypertrophic Obstructive Cardiomyopathy: Systematic Review and Meta-analysis","volume":"42","author":"Osman","year":"2019","journal-title":"Clin. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0140-6736(95)91267-3","article-title":"Non-Surgical Myocardial Reduction for Hypertrophic Obstructive Cardiomyopathy","volume":"346","author":"Sigwart","year":"1995","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1093\/oxfordjournals.eurheartj.a015350","article-title":"Induction of Subaortic Septal Ischaemia to Reduce Obstruction in Hypertrophic Obstructive Cardiomyopathy: Studies to Develop a New Catheter-Based Concept of Treatment","volume":"18","author":"Kuhn","year":"1997","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1161\/01.CIR.79.3.475","article-title":"Transcoronary Chemical Ablation of Ventricular Tachycardia","volume":"79","author":"Brugada","year":"1989","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.euje.2004.01.001","article-title":"Echo-Guided Percutaneous Septal Ablation for Symptomatic Hypertrophic Obstructive Cardiomyopathy: 7 Years of Experience","volume":"5","author":"Faber","year":"2004","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1016\/j.amjcard.2005.12.040","article-title":"Time Course of Pressure Gradient Response after First Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy","volume":"97","author":"Yoerger","year":"2006","journal-title":"Am. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/j.1540-8183.2006.00153.x","article-title":"Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy","volume":"19","author":"Rigopoulos","year":"2006","journal-title":"J. Interv. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1007\/s00392-007-0578-9","article-title":"One-Year Follow-up of Percutaneous Septal Ablation for Symptomatic Hypertrophic Obstructive Cardiomyopathy in 312 patients: Predictors of Hemodynamic and Clinical Response","volume":"96","author":"Faber","year":"2007","journal-title":"Clin. Res. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1093\/eurheartj\/ehv693","article-title":"Long-Term Clinical Outcome after Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy: Results from the Euro-ASA Registry","volume":"37","author":"Veselka","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ijcard.2021.02.056","article-title":"Alcohol Dose in Septal Ablation for Hypertrophic Obstructive Cardiomyopathy","volume":"333","author":"Veselka","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1136\/heartjnl-2019-315422","article-title":"Alcohol Septal Ablation in Patients with Severe Septal Hypertrophy","volume":"106","author":"Veselka","year":"2020","journal-title":"Heart"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e005735","DOI":"10.1161\/JAHA.117.005735","article-title":"Outcome of Alcohol Septal Ablation in Mildly Symptomatic Patients with Hypertrophic Obstructive Cardiomyopathy: A Long-Term Follow-Up Study Based on the Euro-Alcohol Septal Ablation Registry","volume":"6","author":"Veselka","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.jacc.2009.01.079","article-title":"Outcome of Mildly Symptomatic or Asymptomatic Obstructive Hypertrophic Cardiomyopathy","volume":"54","author":"Sorajja","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.cjca.2017.10.020","article-title":"Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy","volume":"34","author":"Veselka","year":"2018","journal-title":"Can. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"900469","DOI":"10.3389\/fcvm.2022.900469","article-title":"Alcohol Septal Ablation or Septal Myectomy? An Updated Systematic Review and Meta-Analysis of Septal Reduction Therapy for Hypertrophic Obstructive Cardiomyopathy","volume":"9","author":"Zheng","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"ezad043","DOI":"10.1093\/ejcts\/ezad043","article-title":"Alcohol Septal Ablation Versus Surgical Septal Myectomy of Obstructive Hypertrophic Cardiomyopathy: Systematic Review and Meta-Analysis","volume":"63","author":"Yokoyama","year":"2023","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"E8143","DOI":"10.1073\/pnas.1809540115","article-title":"Deciphering the Super Relaxed State of Human \u03b2-cardiac Myosin and the Mode of Action of Mavacamten from Myosin Molecules to Muscle Fibers","volume":"115","author":"Anderson","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"16571","DOI":"10.1074\/jbc.M117.776815","article-title":"A Small-Molecule Modulator of Cardiac Myosin Acts on Multiple Stages of the Myosin Chemomechanical Cycle","volume":"292","author":"Kawas","year":"2017","journal-title":"J. Biol. Chem."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"E7486","DOI":"10.1073\/pnas.1720342115","article-title":"Mavacamten Stabilizes an Autoinhibited State of Two-Headed Cardiac Myosin","volume":"115","author":"Rohde","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1126\/science.aad3456","article-title":"A Small-Molecule Inhibitor of Sarcomere Contractility Suppresses Hypertrophic Cardiomyopathy in Mice","volume":"351","author":"Green","year":"2016","journal-title":"Science"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Stern, J.A., Markova, S., Ueda, Y., Kim, J.B., Pascoe, P.J., Evanchik, M.J., Green, E.M., and Harris, S.P. (2016). A Small Molecule Inhibitor of Sarcomere Contractility Acutely Relieves Left Ventricular Outflow Tract Obstruction in Feline Hypertrophic Cardiomyopathy. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0168407"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1080\/00498254.2018.1495856","article-title":"In Vitro and in Vivo Pharmacokinetic Characterization of Mavacamten, a First-in-Class Small Molecule Allosteric Modulator of Beta Cardiac Myosin","volume":"49","author":"Grillo","year":"2019","journal-title":"Xenobiotica"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"741","DOI":"10.7326\/M18-3016","article-title":"Mavacamten Treatment for Obstructive Hypertrophic Cardiomyopathy","volume":"170","author":"Heitner","year":"2019","journal-title":"Ann. Intern. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/S0140-6736(20)31792-X","article-title":"Mavacamten for treatment of Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial","volume":"396","author":"Olivotto","year":"2020","journal-title":"Lancet"},{"key":"ref_41","unstructured":"(2023, July 15). Rader_EXPLORERLTE_Presentation-Slides ACC 2022. Available online: https:\/\/www.acc.org\/Latest-in-Cardiology\/Articles\/2022\/04\/02\/13\/22\/Sun-945am-Treatment-Mavacamten-acc-2022."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1016\/j.jacc.2021.09.1381","article-title":"Effect of Mavacamten on Echocardiographic Features in Symptomatic Patients with Obstructive Hypertrophic Cardiomyopathy","volume":"78","author":"Hegde","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1161\/CIRCULATIONAHA.120.052359","article-title":"Mavacamten Favorably Impacts Cardiac Structure in Obstructive Hypertrophic Cardiomyopathy: EXPLORER-HCM Cardiac Magnetic Resonance Substudy Analysis","volume":"143","author":"Saberi","year":"2021","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jacc.2022.04.048","article-title":"Myosin Inhibition in Patients with Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy","volume":"80","author":"Desai","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1161\/CIRCULATIONAHA.122.062534","article-title":"Dose-Blinded Myosin Inhibition in Patients with Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Outcomes Through 32 Weeks","volume":"147","author":"Desai","year":"2023","journal-title":"Circulation"},{"key":"ref_46","unstructured":"(2023, July 15). 214998s000lbl, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2022\/214998s000lbl.pdf."},{"key":"ref_47","unstructured":"(2023, July 22). HCM-RAAG_16NOV2021.pdf. Available online: https:\/\/icer.org\/wp-content\/uploads\/2021\/11\/HCM-RAAG_16NOV2021.pdf."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jacc.2022.10.020","article-title":"Phase 2 Study of Aficamten in Patients with Obstructive Hypertrophic Cardiomyopathy","volume":"81","author":"Maron","year":"2023","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6628\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:09:57Z","timestamp":1760130597000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6628"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,19]]},"references-count":48,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jcm12206628"],"URL":"https:\/\/doi.org\/10.3390\/jcm12206628","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,19]]}}}