003| Volume 26, ISSUE 10, SUPPLEMENT , S2-S3, October 2020

The Effect of the Cardiac Myosin Activator, Omecamtiv Mecarbil, on Right Ventricular Structure and Function in Chronic Systolic Heart Failure (cosmic-hf)


      Omecamtiv mecarbil (OM) is a cardiac myotrope which selectively activates cardiac myosin and thereby increases cardiac contractility. The aim of the current study was to determine the effect of therapy with OM on right ventricular (RV) structure and function in patients with heart failure (HF).


      In the COSMIC-HF trial, 448 patients with stable, symptomatic HF and left ventricular ejection fraction (LVEF) <40% were randomly assigned to double-blind oral OM [25 mg twice daily; or 25 mg twice daily with pharmacokinetic-guided uptitration to 50 mg twice daily (PK group)] or placebo for 20 weeks. RV systolic ejection time (RV-SET), TAPSE, RV end-systolic (RV-ESA) and end-diastolic area (RV-EDA), RV outflow tract velocity time integral (RVOT-VTI), pulmonary arterial systolic pressure (PASP), TAPSE/PASP ratio and RVOT-VTI/PASP ratio were assessed between the placebo (n=149), the 25 mg group (n=150) and the PK group (n=149) at week 20.


      Patients were 63±11 years old with LVEF of 29.1±7.3%. OM had no effect on RV-EDA nor TAPSE (Figure). However, OM significantly improved several measures of RV function such as RV-SET, RV-ESA, RVOT-VTI together with measures of RV pulmonary arterial coupling (PASP, TAPSE/PASP ratio and RVOT-VTI/PASP ratio) (Figure).


      In patients with chronic HF and reduced systolic function, 20 weeks of OM treatment was associated with improvement in several measures of RV function together with improvement in measures of RV pulmonary arterial coupling.
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