Mariko Harper, MD

Invasive Treatment Options in Hypertrophic Cardiomyopathy 

In the final episode, Invasive Treatment Options in Hypertrophic Cardiomyopathy, the panelists explored the following critical question:

What is the role of invasive procedures for hypertrophic cardiomyopathy?

Led by the moderator, the experts examine invasive procedures, which play a critical role in the management of hypertrophic cardiomyopathy (HCM) for patients who remain symptomatic despite optimal medical therapy. Septal myectomy and alcohol septal ablation are the primary interventions used to reduce left ventricular outflow tract obstruction and improve symptoms such as dyspnea, chest pain, and syncope. These procedures are typically considered for patients with severe obstruction or functional limitations, and careful patient selection is essential to optimize outcomes. When performed by experienced centers, invasive interventions can significantly improve quality of life, functional capacity, and long-term prognosis in patients with obstructive HCM.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

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Learn when cardiac myosin inhibitors suffice and when myectomy or alcohol ablation fits, with shared decisions at expert HCM centers.

Insights from the MAPLE Trial: Clinical Implications for oHCM Management 

This episode, titled Insights from the MAPLE Trial: Clinical Implications for oHCM Management, features panelists discussing the following question:

Can you please discuss the MAPLE trial and its clinical implications?

Led by Dr. Maron, Drs. Harper, Le, and Rader examined the MAPLE trial, which provides important comparative data on the efficacy and safety of aficamten versus standard therapy in patients with symptomatic obstructive hypertrophic cardiomyopathy. Findings from the study highlight improvements in hemodynamic parameters, symptom burden, and functional capacity, supporting the role of cardiac myosin inhibition as a targeted treatment approach. The trial also offers insight into how newer therapies may fit into existing treatment algorithms alongside traditional agents. These results have meaningful clinical implications, particularly in guiding personalized treatment decisions and optimizing patient outcomes in real-world practice.

In the next episode, Invasive Treatment Options in Hypertrophic Cardiomyopathy, panelists will continue their discussion on the role of invasive procedures, such as septal myectomy and alcohol septal ablation, in the management of hypertrophic cardiomyopathy. It highlights patient selection, expected outcomes, and how these interventions fit within the broader treatment landscape.

MAPLE HCM reveals aficamten beats beta blockers in obstructive HCM, reshaping first-line therapy debates amid insurance hurdles.

Differentiating Cardiac Myosin Inhibitors: Clinical Considerations and Drug Interactions

In Differentiating Cardiac Myosin Inhibitors: Clinical Considerations and Drug Interactions, our panel/experts delve(s) into the following critical questions:

How are you differentiating between the 2 FDA-approved cardiac myosin inhibitors, mavacamten and aficamten?

Do the different pharmacokinetics between the 2 impact your treatment decisions?

Led by Dr. Martin Maron, the Drs. Harper, Rader, and Le discuss differentiation between mavacamten and aficamten, which often centers on their pharmacokinetic profiles, including half-life, time to steady state, and flexibility in dose adjustments. These differences can influence how quickly clinicians can titrate therapy and respond to changes in patient status or adverse effects. Aficamten’s shorter half-life may allow for more rapid dose optimization and potentially easier management in situations requiring interruption, while mavacamten’s longer half-life may require more cautious adjustments. As a result, pharmacokinetics can play an important role in treatment decisions, particularly when considering patient-specific factors such as comorbidities, concomitant medications, and the need for close monitoring.

Explore how aficamten’s shorter half-life enables faster titration, flexible echo monitoring, and fewer drug interactions—making HCM treatment more patient-friendly and accessible.

Advancing Cardiac Myosin Inhibitor Therapy: Evidence, Monitoring, and Clinical Integration

In this episode, Advancing Cardiac Myosin Inhibitor Therapy: Evidence, Monitoring, and Clinical Integration, the cardiovascular experts explore the following questions:

What are the best practices for monitoring patients for treatment response and adverse events once they’ve initiated a cardiac myosin inhibitor?

What are best practices when working with REMS programs with these therapies?

Aficamten was also FDA-approved in December 2025 for symptomatic obstructive hypertrophic cardiomyopathy. What was the trial design of SEQUOIA-HCM?

The panelists covered best practices for monitoring patients on cardiac myosin inhibitors, which include regular assessment of symptoms, functional capacity, and serial echocardiography to evaluate left ventricular outflow tract gradients and ejection fraction. Close monitoring is essential to detect potential adverse effects, particularly reductions in systolic function, and to guide dose adjustments or temporary treatment interruption if needed. Effective management within REMS programs requires coordinated workflows, timely documentation, and clear communication with patients to ensure compliance with safety monitoring requirements. The SEQUOIA-HCM trial evaluating aficamten was a randomized, controlled study designed to assess its impact on exercise capacity, symptom improvement, and hemodynamic measures in patients with symptomatic obstructive hypertrophic cardiomyopathy.

The next episode in this series, Differentiating Cardiac Myosin Inhibitors: Clinical Considerations and Drug Interactions, features the panelists advancing their conversation on key differences between mavacamten and aficamten, including pharmacokinetic profiles and how they may influence treatment selection in clinical practice. It also reviews potential drug–drug interactions associated with each therapy and their implications for safe and effective use.

When beta blockers fall short in obstructive HCM, explore myosin inhibitors, disopyramide, or septal reduction—and see why patients breathe easier.

Mariko Harper, MD

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