AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Metabolic and Hemodynamic Outcomes of Glucagon-Like Peptide-1 Therapy in Hypertrophic Obstructive Cardiomyopathy With and Without Mavacamten
By Raman D, Paik K, Sundaravel S
Background: Obesity and metabolic disease are common in hypertrophic obstructive cardiomyopathy (HOCM) and may contribute to symptom burden and adverse outcomes. The most common side effects in patients using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are dehydration and syncope, both of which can be exaggerated in patients with HOCM. The tolerability and clinical effects of GLP-1 RAs in patients with HOCM receiving mavacamten (MAVA) remain unclear. We evaluated the clinical characteristics and outcomes of patients with HOCM treated with GLP-1 therapy with and without concomitant MAVA. Hypothesis: We hypothesized that GLP-1 RA therapy would be well tolerated in patients with HOCM receiving MAVA when the left ventricular outflow tract (LVOT) gradients are better controlled. Methods: We performed a retrospective single-center study of HOCM patients at a tertiary referral hospital who are prescribed GLP-1 RAs, stratified by MAVA use. Echocardiographic, hemodynamic, and clinical outcomes were assessed at GLP-1 RA initiation and follow-up. Group comparisons used t-tests or Fisher’s exact tests; longitudinal analyses included only patients with paired baseline and follow-up data. Results: 27 patients were included (13 GLP-1 and MAVA; 14 GLP-1 without MAVA). Mean age was 59.8 ± 12.1 years and 70% female. In the overall cohort, 70% had diabetes, 93% hypertension, 48% coronary artery disease, 22% atrial fibrillation and chronic kidney disease, and 33% pacemaker implantation. The mean MAVA duration was 20.9 ± 8.6 months. Percent weight loss was 9.0 ± 10.8% vs 11.2 ± 9.5% ( p = 0.59 ). Change in LVEF was -3.1 ± 3.8% vs +3.0 ± 8.6% ( p = 0.03 ), explained by the use of MAVA. Greater reduction in systolic blood pressure was seen in the GLP-1 only group (-10.2 ± 18.9 mmHg vs -24.2 ± 19.5 mmHg; p = 0.06 ). Resting LVOT gradient decreased in both groups with a trend towards greater gradient reduction in the MAVA group (-18.7 ± 39.5 mmHg vs -7.4 ± 18.9 mmHg; p = 0.49 ), with similar trends seen in provoked gradients. NYHA improvement occurred more frequently in the combination group (42% vs 17%; p = 0.19 ). Rates of heart failure hospitalization (15% vs 21%; p = 1.0 ), syncope (0% vs 21%; p = 0.22 ), gastrointestinal side effects (38% vs 21%; p = 0.42 ), and hypotension (8% vs 14%; p = 1.0 ) were similar between groups. Although the rates of syncope and hypotension were numerically higher in the GLP-1 RA group without concomitant MAVA use, we did not reach statistical significance due to the small sample size. Conclusions: In this cohort, weight loss and reductions in LVOT gradients were similar between groups. Most adverse events occurred less frequently in the combination group, although differences were not statistically significant. These findings suggest that GLP-1 RA therapy may be used safely alongside MAVA with careful monitoring, though larger studies are needed to clarify potential clinical outcomes.