This retrospective cohort study aims to evaluate the clinical efficacy and safety of mavacamten in adult patients with obstructive hypertrophic cardiomyopathy (oHCM). A total of 222 patients were included and categorized based on treatments received in routine clinical practice into a mavacamten group and a standard therapy group.

The primary outcome is the change in resting left ventricular outflow tract (LVOT) gradient at Week 30. Secondary outcomes include changes in Valsalva LVOT gradient, New York Heart Association (NYHA) functional class, cardiac biomarkers, and echocardiographic parameters. Safety outcomes include adverse events and left ventricular systolic dysfunction.

This study provides real-world evidence on the effectiveness and safety of mavacamten in Chinese patients with oHCM.

Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disorder characterized by left ventricular hypertrophy, with approximately two-thirds of patients presenting with obstructive physiology. Obstructive hypertrophic cardiomyopathy (oHCM) is associated with significant morbidity due to left ventricular outflow tract (LVOT) obstruction.

Mavacamten, a first-in-class cardiac myosin inhibitor, directly targets the underlying pathophysiology of oHCM by reducing excessive myosin-actin cross-bridge formation. Although previous randomized clinical trials, such as EXPLORER-CN, have demonstrated its efficacy, real-world data in Chinese populations remain limited.

This study is a retrospective cohort study conducted at Fuwai Central China Cardiovascular Hospital. Patients were not assigned to interventions. Instead, they were categorized based on treatments received in routine clinical practice. Eligible adult patients with oHCM who initiated mavacamten therapy were included in the treatment group, while patients receiving standard pharmacological therapy served as the control group.

Clinical data were collected from January 2024 to May 2025, with final database lock completed in June 2025. Baseline characteristics, echocardiographic parameters, and laboratory biomarkers were obtained from medical records.

The primary endpoint was the change in resting LVOT peak gradient at Week 30 compared with baseline. Secondary endpoints included changes in Valsalva LVOT gradient, NYHA functional class improvement, NT-proBNP, high-sensitivity cardiac troponin I (hs-cTnI), left ventricular ejection fraction (LVEF), and tricuspid annular plane systolic excursion (TAPSE). Safety endpoints included adverse events, serious adverse events, treatment discontinuation, and reduction of LVEF below 50%.

This study aims to provide real-world evidence regarding the clinical effectiveness and safety of mavacamten in adult patients with oHCM in China.

Inclusion Criteria:

• Age ≥18 years
• Diagnosis of hypertrophic cardiomyopathy
• NYHA functional class II-III
• First-time treatment with mavacamten

Exclusion Criteria:

• Known hypersensitivity to mavacamten or its components
• Left ventricular ejection fraction (LVEF) <55%
• Septal reduction therapy within 6 months prior to enrollment
• Presence of other conditions requiring long-term anticoagulation
• Pregnancy or breastfeeding
• Any condition deemed unsuitable by the investigator

Adult patients diagnosed with obstructive hypertrophic cardiomyopathy who received treatment at Fuwai Central China Cardiovascular Hospital between January 2024 and May 2025 in routine clinical practice.

Individual participant data (IPD) sharing has not yet been determined. Due to the retrospective nature of this study and the use of de-identified clinical data, any potential data sharing will be considered in accordance with institutional policies, ethical approvals, and applicable data protection regulations.