Background
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).
Methods
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.
Results
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).
Conclusion
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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Copyright
© 2020 Published by Elsevier Inc.
