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Valsartan in early-stage hypertrophic cardiomyopathy: a randomized phase 2 trial.

MedStar author(s):

1078-8956

Abstract: Hypertrophic cardiomyopathy (HCM) is often caused by pathogenic variants in sarcomeric genes and characterized by left ventricular (LV) hypertrophy, myocardial fibrosis and increased risk of heart failure and arrhythmias. There are no existing therapies to modify disease progression. In this study, we conducted a multi-center, double-blind, placebo-controlled phase 2 clinical trial to assess the safety and efficacy of the angiotensin II receptor blocker valsartan in attenuating disease evolution in early HCM. In total, 178 participants with early-stage sarcomeric HCM were randomized (1:1) to receive valsartan (320 mg daily in adults; 80-160 mg daily in children) or placebo for 2 years ( NCT01912534 ). Standardized changes from baseline to year 2 in LV wall thickness, mass and volumes; left atrial volume; tissue Doppler diastolic and systolic velocities; and serum levels of high-sensitivity troponin T and N-terminal pro-B-type natriuretic protein were integrated into a single composite z-score as the primary outcome. Valsartan (n = 88) improved cardiac structure and function compared to placebo (n = 90), as reflected by an increase in the composite z-score (between-group difference +0.231, 95% confidence interval (+0.098, +0.364); P = 0.001), which met the primary endpoint of the study. Treatment was well-tolerated. These results indicate a key opportunity to attenuate disease progression in early-stage sarcomeric HCM with an accessible and safe medication. Copyright (c) 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.All authors: Axelsson A, Bach RG, Becker JR, Benson L, Braunwald , Bundgaard H, Burns KM, Canter C, Cirino AL, Colan SD, Day SM, Ho CY, Lakdawala NK, Lever HM, MacRae CA, Margossian R, McMurray JJV, Mestroni L, Murphy AM, Orav EJ, Owens AT, Patel AR, Pereira AC, Rossano JW, Russell MW, Seidman CE, Solomon SD, Soslow JH, Taylor MRG, Thrush P, VANISH Investigators, Vargas JD, Wheeler MT, Wilmot I, Zahka KFiscal year: FY2022Digital Object Identifier:

https://dx.doi.org/10.1038/s41591-021-01505-4

Date added to catalog: 2021-11-01

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Title notes ( 2 )

Holdings
Item type	Current library	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	34556856	Available		34556856

Hypertrophic cardiomyopathy (HCM) is often caused by pathogenic variants in sarcomeric genes and characterized by left ventricular (LV) hypertrophy, myocardial fibrosis and increased risk of heart failure and arrhythmias. There are no existing therapies to modify disease progression. In this study, we conducted a multi-center, double-blind, placebo-controlled phase 2 clinical trial to assess the safety and efficacy of the angiotensin II receptor blocker valsartan in attenuating disease evolution in early HCM. In total, 178 participants with early-stage sarcomeric HCM were randomized (1:1) to receive valsartan (320 mg daily in adults; 80-160 mg daily in children) or placebo for 2 years ( NCT01912534 ). Standardized changes from baseline to year 2 in LV wall thickness, mass and volumes; left atrial volume; tissue Doppler diastolic and systolic velocities; and serum levels of high-sensitivity troponin T and N-terminal pro-B-type natriuretic protein were integrated into a single composite z-score as the primary outcome. Valsartan (n = 88) improved cardiac structure and function compared to placebo (n = 90), as reflected by an increase in the composite z-score (between-group difference +0.231, 95% confidence interval (+0.098, +0.364); P = 0.001), which met the primary endpoint of the study. Treatment was well-tolerated. These results indicate a key opportunity to attenuate disease progression in early-stage sarcomeric HCM with an accessible and safe medication. Copyright (c) 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.

English