Kallash Mohammed, Frishman William H, Aronow Wilbert S
Department of Medicine, School of Medicine, New York Medical College, New York, US.
Westchester Medical Center, Valhalla, New York, US.
Arch Med Sci Atheroscler Dis. 2025 May 28;10:e43-e47. doi: 10.5114/amsad/205547. eCollection 2025.
Heart failure (HF) is a growing global epidemic resulting in significant morbidity and mortality. The pathophysiology of HF with reduced ejection fraction (HFrEF) is characterized by impaired systolic function resulting in diminished cardiac output. A new class of inotropes, cardiac myosin activators were developed to directly augment cardiac sarcomere function and improve myocardial activity in HFrEF. The first drug in this class, omecamtiv mecarbil selectively activates cardiac myosin and improves cardiac contractility by increasing the efficiency of the actin-myosin cross-bridge cycle, increasing the duration of systolic ejection without raising myocardial oxygen demand. The first major trial investigating omecamtiv mecarbil use in HFrEF demonstrated a statistically significant decrease in the composite endpoint of the first HF event or death from cardiovascular causes. A post hoc analysis demonstrated that omecamtiv mecarbil produced a statistically significant reduction in the composite endpoint of time to the first HF event or cardiovascular death among patients with severe HFrEF.
心力衰竭（HF）是一种在全球范围内日益流行的疾病，会导致严重的发病率和死亡率。射血分数降低的心力衰竭（HFrEF）的病理生理学特征是收缩功能受损，导致心输出量减少。一类新型的强心药——心肌肌球蛋白激活剂被开发出来，以直接增强心肌肌节功能并改善HFrEF患者的心肌活性。这类药物中的第一种，奥米卡替麦卡比可选择性激活心肌肌球蛋白，并通过提高肌动蛋白-肌球蛋白横桥循环的效率来改善心脏收缩力，增加收缩期射血时间，而不增加心肌需氧量。第一项研究奥米卡替麦卡比在HFrEF中应用的大型试验表明，首次发生心力衰竭事件或心血管原因死亡的复合终点有统计学意义的降低。一项事后分析表明，在严重HFrEF患者中，奥米卡替麦卡比使首次发生心力衰竭事件或心血管死亡的复合终点时间有统计学意义的降低。
