Exercise Performance With Aficamten vs Metoprolol in Obstructive Hypertrophic Cardiomyopathy: Insights from the MAPLE-HCM Phase 3 Randomized Trial

Highlights

• The MAPLE-HCM trial is the first large-scale, head-to-head, phase 3 randomized trial comparing aficamten, a selective cardiac myosin inhibitor, with metoprolol, the longstanding first-line β-blocker therapy for symptomatic oHCM.
• Aficamten monotherapy demonstrated superior improvements in multiple exercise parameters, including peak oxygen uptake (pVO2), submaximal ventilation efficiency (VE/VCO2 slope), anaerobic threshold, and circulatory power, compared with metoprolol.
• Beyond exercise capacity, aficamten showed enhanced patient-reported health status and quality of life, significant reductions in left ventricular outflow tract gradients (LVOT-G), and favorable echocardiographic remodeling compared with metoprolol.
• Safety profiles were comparable, with aficamten exhibiting modest reductions in left ventricular ejection fraction consistent with its mechanism but without adverse hemodynamic compromise.

Background