Authors and Affiliations
Mustafa Suppah, MD; Kaitlin Roehl, P.A.-C; Kate Lew, APRN, N.P, M.S.N; Reza Arsanjani, MD; Steven Lester, MD; Susan Wilansky, MD; Charles Cannan, MD; Chadi Ayoub, MD, PhD; Steve Ommen, MD; Jeffrey Geske, MD; Konstantinos Siontis, MD; Hartzell Schaff, MD; Said Alsidawi, MD.

Background
Our study aims to assess the impact of mavacamten, a novel myosin inhibitor, and surgical myectomy on cardiomyocyte remodeling in patients with obstructive hypertrophic cardiomyopathy (oHCM) using an artificial intelligence (AI)-ECG platform.

Methods
Our analysis included 34 patients with oHCM with an average age of 62 (40-75) years old, using our database from 2020 to 2023. Patients were stratified into a group of 16 patients who received 12 weeks of mavacamten, and a group of 18 patients who underwent myectomy with 1 year of follow-up. Patients with known atrial fibrillation (AF) and post-operative AF or left bundle branch block were excluded. Our primary outcomes included changes of left ventricular outflow tract (LVOT) gradient and probabilities of AF, and HCM detectability as assessed by validated AI-ECG algorithms.

Results
Patients treated with mavacamten had reduced AI-ECG assessed AF risk (18.89% to 14.97%, P=0.025), while myectomy patients had no significant change. AI-ECG scores for HCM detectability decreased in both groups, with the decrease reaching statistical significance in the mavacamten group (57.07% to 33.58%, p<0.001). LVOT gradients improved significantly in both groups: myectomy (79.94±27.06 to 20.05±27.97, P=0.0005) and mavacamten (75.75±20.58 to 42.87±33.55, P=0.005).

Conclusion
Mavacamten may be associated with a more favorable impact on positive remodeling, potentially indicating a broader effect on myocytes beyond LVOT obstruction relief.

**Authors and Affiliations**
Mustafa Suppah, MD; Kaitlin Roehl, P.A.-C; Kate Lew, APRN, N.P, M.S.N; Reza Arsanjani, MD; Steven Lester, MD; Susan Wilansky, MD; Charles Cannan, MD; Chadi Ayoub, MD, PhD; Steve Ommen, MD; Jeffrey Geske, MD; Konstantinos Siontis, MD; Hartzell Schaff, MD; Said Alsidawi, MD.

**Background**
Our study aims to assess the impact of mavacamten, a novel myosin inhibitor, and surgical myectomy on cardiomyocyte remodeling in patients with obstructive hypertrophic cardiomyopathy (oHCM) using an artificial intelligence (AI)-ECG platform.

**Methods**
Our analysis included 34 patients with oHCM with an average age of 62 (40-75) years old, using our database from 2020 to 2023. Patients were stratified into a group of 16 patients who received 12 weeks of mavacamten, and a group of 18 patients who underwent myectomy with 1 year of follow-up. Patients with known atrial fibrillation (AF) and post-operative AF or left bundle branch block were excluded. Our primary outcomes included changes of left ventricular outflow tract (LVOT) gradient and probabilities of AF, and HCM detectability as assessed by validated AI-ECG algorithms.

**Results**
Patients treated with mavacamten had reduced AI-ECG assessed AF risk (18.89% to 14.97%, P=0.025), while myectomy patients had no significant change. AI-ECG scores for HCM detectability decreased in both groups, with the decrease reaching statistical significance in the mavacamten group (57.07% to 33.58%, p<0.001). LVOT gradients improved significantly in both groups: myectomy (79.94±27.06 to 20.05±27.97, P=0.0005) and mavacamten (75.75±20.58 to 42.87±33.55, P=0.005).

**Conclusion**
Mavacamten may be associated with a more favorable impact on positive remodeling, potentially indicating a broader effect on myocytes beyond LVOT obstruction relief.

Assessment of Positive Cardiac Remodeling in Hypertrophic Obstructive Cardiomyopathy using an AI-ECG Platform in Patients Treated with Mavacamten or Myectomy