Work

Decompensated heart failure after one year of successful therapy with mavacamten: a case report

Year: 2026

Type: article

Abstract: Background: Cardiac myosin inhibition is the first disease-specific therapeutic strategy for obstructive hypertrophic cardiomyopathy. Mavacamten, the first-in-class agent, has demonstrated an excellent safety profile and sustained efficacy in both clinical trials and real-world practice. However, its safe use requires careful monitoring and thorough patient education regarding potential drug-drug interactions. Case summary: We report a case of acute heart failure occurring after long-term clinical stability on mavacamten following concomitant fluconazole administration. It is reasonable to assume that the pharmacokinetic interaction resulted in excessive mavacamten exposure, leading to transient systolic dysfunction, severe functional mitral regurgitation, and adverse left ventricular remodelling. Discussion: This case report highlights the consequences of pharmacological interactions between mavacamten and a strong CYP2C19 inhibitor. Drug-drug interaction should always be considered and systematically excluded in a patient presenting with unexplained heart failure and left ventricular remodelling during mavacamten therapy.

Source: European Heart Journal - Case Reports

DOI: 10.1093/ehjcr/ytag741

Authors: Giulia Marchionni, Lucrezia Netti, Silvia Stavagna, Cristina Chimenti

Institution: Sapienza University of Rome

Language: English

Topic: Cardiomyopathy and Myosin Studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $815