AFICAMTEN significantly improves exercise performance in patients with symptomatic obstructive hypertrophic cardiomyopathy (oHCM), according to evidence from the Phase III MAPLE-HCM clinical trial.1
Hypertrophic cardiomyopathy is the most common inherited cardiac disease, estimated to affect up to 1 in 250 people worldwide.2 The disease is characterised by unexplained thickening of the heart’s muscle wall. HCM’s pathophysiology acts as a restraint on cardiac function during physical activity, limiting exercise tolerance in patients living with oHCM.1
Beta-blockers, such as Metoprolol, have traditionally been first-line therapy for the management of oHCM. For the first time in over 50 years, new evidence supports a shift to cardiac myosin inhibitor Aficamten as a first-line therapy for oHCM.
Aficamten Outperforms Metoprolol Across All Exercise Measures
The analysis included 175 randomised participants with symptomatic oHCM and evidenced exercise intolerance. For 24 weeks, patients received either 5 to 20 mg Aficamten or 50 to 200 mg Metoprolol daily.
Compared with Metoprolol, Aficamten improved several key measures of exercise performance. Ventilatory efficiency improved significantly (p<0.001) and oxygen uptake at the anaerobic threshold also increased (p<0.001).
At peak exercise, Aficamten was associated with higher peak oxygen uptake (p<0.001), increased peak workload (p=0.003), and longer exercise duration (p=0.002), while deterioration was noted in the Metoprolol group across all peak performance metrics.
Aficamten also improved postexercise recovery. The time required for oxygen uptake to decline by 12.5% following exercise was reduced by 11 seconds compared with Metoprolol (p<0.001).
Aficamten Signals New Frontier for oHCM Patients
The researchers concluded that Aficamten was superior to Metoprolol across multiple phases of exercise, supporting consideration of Aficamten as a first line monotherapy for improving functional capacity in patients with oHCM.
These findings arrive amid growing public and clinical attention on HCM. Public figures such as NBA player Jared Butler,3 who has spoken about being diagnosed with HCM during college screening, have drawn attention to the importance of cardiac evaluation and symptom recognition in young, active populations.
As awareness grows, these results mark a meaningful step forward in improving exercise tolerance, daily function and quality of life for people living with oHCM.1
References
1Lewis GD et al. Exercise Performance with Aficamten vs Metoprolol in Obstructive Hypertrophic Cardiomyopathy: The MAPLE-HCM Randomized Clinical Trial. JAMA Cardiol. 2026; DOI:10.1001/jamacardio.2026.1730.
2Brögger MN et al. Genetics in Hypertrophic Cardiomyopathy: An Evolving Clinical Landscape. Card Fail Rev. 2026; DOI: 10.15420/cfr.2025.12.
3ABC News. How an NBA player’s genetic heart disease led to advocacy for hypertrophic cardiomyopathy. 2021. Available at: https://abcnews.com/Health/nba-players-genetic-heart-disease-led-advocacy-hypertrophic/story. Last Accessed: 19 June 2026.
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