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Multi-site infective endocarditis complicated by a left ventricular abscess and pseudoaneurysm: A case report

Mahima Tyagi, Tori Seasor, Mark S Slaughter

Native valve infective endocarditis (IE) is rare, with an incidence of 3–7 cases per 100,000 person-years.1,2 Cardiac structural complications from local infection extension include valvular destruction, peri-annular abscess and fistula formation. Left ventricular pseudoaneurysm (LVP) from IE is exceedingly rare, occurring in <1% of cases, and is associated with high morbidity and mortality. Diagnosis is challenging due to nonspecific symptoms […]

Heart International. 2026;20(2):Online ahead of journal publication

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CE/CME accredited

Updates in hypertrophic cardiomyopathy care: Bridging the current treatment gaps with emerging novel therapies

Topics Covered:
Heart Failure Arrhythmia Atrial Fibrillation Congenital Conditions
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Tutorial

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Poll

What is a key gap in clinical care provision for patients with HCM?

Submit your answer to see the results and continue the video
Biomarkers for assessing response to cardiac myosin inhibitors
   
Risk stratification tools for nonobstructive HCM
   
Algorithm to guide anticoagulation therapy for subclinical AF
   
Predictors for sudden cardiac death
   

Tutorial

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Poll

Which class of investigational agent is promising for high-risk nonobstructive HCM?

Submit your answer to see the results and continue the video
Cardiac myosin inhibitor (aficamten)
   
SGLT2-inhibitor (dapagliflozin, empagliflozin)
   
Cardiac mitotrope (ninerafaxstat)
   
Cardiac sarcomere modulator (EDG-7500)
   
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Interview Questions
About Dr Martin Maron

In this interview, Dr Martin Maron answers the following questions:

  1. What do we currently know about the underlying pathobiology of HCM?
  2. How is symptomatic obstructive HCM currently managed?
  3. What is nonobstructive HCM, and how should symptomatic disease be managed?
  4. How does atrial fibrillation affect outcomes in patients with HCM, and what are best practices for its management?
  5. What developments do you think have particular promise for addressing the unmet needs of patients with HCM?

Dr Martin Maron is the director of the Hypertrophic Cardiomyopathy Center Lahey Medical Center and Hospital.

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His research interests are the diagnosis and management of hypertrophic cardiomyopathy, including identification of patients at high risk for sudden death, as well as the role of cardiovascular magnetic resonance and ambulatory monitoring in assessment of patients with HCM and novel drug therapy to modify the disease. Dr Maron has co-authored over 250 original publications on HCM including in the New England Journal of Medicine, Lancet, Circulation and Journal of the American College of Cardiology.

Dr Martin Maron discloses: Advisory board/panel fees from Cytokinetics Inc. Consultancy fees from Edgewise Therapeutics and Imbria Pharmaceuticals.

Interview Questions
About Dr Michelle Michels

In this interview, Dr Michelle Michels answers the following questions:

  1. What are cardiac myosin inhibitors, and what is the rationale for using them to manage HCM?
  2. What clinical data support the use of mavacamten in the treatment and management of obstructive HCM?
  3. What trials are ongoing with mavacamten in obstructive HCM and how may they inform patient management with CMIs in the future?
  4. What data are available for the treatment of obstructive HCM using aficamten?
  5. What trials are ongoing with aficamten?
  6. What can we learn from available data on the management of nonobstructive HCM with CMIs?
  7. What other therapeutic approaches are currently under investigation for addressing the unmet needs of patients with HCM?
  8. How do you see approved and emerging therapeutic approaches addressing the unmet treatment needs of patients with HCM?

Dr Michelle Michels is an associate professor and the director of the Erasmus MC Center of Expertise for Inherited Cardiovascular Diseases, a national approved expertise centre, which is also part of ERN GUARD-Heart.

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Her focus is clinical care of patients with hypertrophic cardiomyopathy (HCM). She is involved in a number of research projects, investigating the pathophysiologic mechanisms and genotype–phenotype relations in HCM. Dr Michelle Michels has authored or co-authored over 200 papers and book chapters in HCM.

 

Dr Michelle Michels discloses: Advisory board/panel fees from Bayer, Bristol Myers Squibb and Novo Nordisk. Consultancy fees from Alnylam, Bristol Myers Squibb, Cytokinetics Inc. and Kardigan. Grants/research support from Bristol Myers Squibb.

Expert Interviews

Dr Martin Maron

What are the current conventional pharmacological treatments for HCM and what unmet needs remain?
Duration: 18:32

Dr Michelle Michels

What therapeutic classes are emerging for HCM and what is the latest evidence for their use?
Duration: 12:43

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Updates in hypertrophic cardiomyopathy care: Bridging the current treatment gaps with emerging novel therapies

0.75 CE/CME credit

Question 1 of 5

How do cardiac myosin inhibitors work to reduce the impact of symptoms in oHCM?

Abbreviations
LVOT-G, left ventricular outflow tract; NOS, nitrous oxide; oHCM, obstructive hypertrophic cardiomyopathy.

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HCM is characterized by an exaggerated interaction between myosin and actin filaments in the heart muscle.1 Cardiac myosin inhibitors reduce the rate of inorganic phosphate release from myosin, leading to prolongation of the ATPase cycle length with resultant reductions in ATPase activity, actomyosin crossbridge formation, and ultimately, contractile force generation.2

Abbreviations

ATP, adenosine triphosphate; HCM, hypertrophic cardiomyopathy.

References

  1. Dicorato MM, et al. Biomedicines. 2025;13:1256.
  2. Ostrominski JW, et al. JACC Heart Fail. 2023;11:735–48.
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Updates in hypertrophic cardiomyopathy care: Bridging the current treatment gaps with emerging novel therapies

0.75 CE/CME credit

Question 2 of 5

Your patient has persistent symptomatic nHCM with LVEF ≥50%. What currently available therapeutic option may offer clinical benefit to improve symptoms?

Abbreviations
ACE, angiotensin-converting enzyme; LVEF, left ventricle ejection fraction; nHCM, nonobstructive hypertrophic cardiomyopathy.

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Pharmacological therapeutic options are still limited for patients with nHCM; it remains a significant unmet need. Drug therapy using beta-blockers or calcium channel blockers is often ineffective, and currently, there are no approved medications that specifically target the underlying pathophysiological mechanisms in nHCM.

Abbreviation

nHCM, nonobstructive hypertrophic cardiomyopathy.

Reference

Ordine L, et al. Heart Fail Rev. 2025. doi: 10.1007/s10741-025-10535-w. Online ahead of print.

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Updates in hypertrophic cardiomyopathy care: Bridging the current treatment gaps with emerging novel therapies

0.75 CE/CME credit

Question 3 of 5

Your patient with nHCM has a reduced QoL due to breathlessness, fatigue and palpitations. Therapy with CCBs has not improved his symptoms. What do you recommend for this patient?

Abbreviations
CCB, calcium channel blocker; echo, echocardiogram; nHCM, nonobstructive hypertrophic cardiomyopathy; QoL, quality of life.

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In patients with nHCM and advanced HF (NYHA functional class III to class IV), cardiopulmonary exercise stress testing should be performed to quantify the degree of functional limitation and aid in selection of patients for heart transplantation or mechanical circulatory support.1 Assessment of cardiac structure and function and haemodynamic response with exertion is a key component of the investigation.2 The focus of the test is to assess provokable LVOT obstruction and diastolic function to help identify the factors implicated in the symptoms of dyspnoea.2  

Abbreviations

HF, heart failure; LVOT, left ventricular outflow tract; nHCM, nonobstructive hypertrophic cardiomyopathy; NYHA, New York Heart Association.

References

  1. Ommen SR, et al. Circulation. 2024;149:e1239–311.
  2. Lukas Laws J, et al. Curr Cardiol Rep. 2024;26:1461–9.
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Updates in hypertrophic cardiomyopathy care: Bridging the current treatment gaps with emerging novel therapies

0.75 CE/CME credit

Question 4 of 5

Which characteristic best distinguishes aficamten from mavacamten in the treatment of HCM?

Abbreviation

HCM, obstructive hypertrophic cardiomyopathy.

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Aficamten, the next-in-class CMI, was engineered with the goal of achieving a number of specific pharmacological properties including a half-life that would enable dose escalation as frequently as every 2 weeks.

Abbreviation

CMI, cardiac myosin inhibitor.

Reference

Coates CJ, et al. J Am Heart Assoc. 2024;15:e035993.

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Updates in hypertrophic cardiomyopathy care: Bridging the current treatment gaps with emerging novel therapies

0.75 CE/CME credit

Question 5 of 5

You are currently treating a patient with oHCM with mavacamten + BBs. His overall “feel and function” have improved with mavacamten, but he is experiencing persistent fatigue. You are considering discontinuing BB therapy. What impact would you expect this to have on his outcomes, based on results from long-term clinical trials?

Abbreviations
BB, beta-blocker; CCB, calcium channel blocker; LVOT-G, left ventricular outflow tract-gradient; mava, mavacamten; MT, monotherapy; NYHA, New York Heart Association; oHCM, obstructive hypertrophic cardiomyopathy.

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The integrated analysis of the EXPLORER-HCM, MAVA-LTE, VALOR-HCM and EXPLORER-CN trials included 426 patients with oHCM, 25 of whom received monotherapy while the remaining patients received either mava-BB (n=328) or mava-CCB (n=82). Measures included changes in resting and Valsalva LVOT-G, NYHA and incidence of TEAEs. Similar improvements in resting and Valsalva LVOT-G and NYHA class were observed in all LTE-mavacamten exposure groups. Likewise comparable proportions of patients in all treatment groups experienced TEAEs.

Abbreviations

BB, beta-blocker; CCB, calcium channel blocker; LTE, long-term extension; LVOT-G, left ventricular outflow tract-gradient; mava, mavacamten; NYHA, New York Heart Association; oHCM, obstructive hypertrophic cardiomyopathy; TEAE, treatment-emergent adverse event.

Reference

Olivotto I, et al. Integrated efficacy and safety analysis of mavacamten monotherapy in patients with oHCM. Presented at: ESC Congress 2025, Madrid Spain. 29 August–1 September 2025.

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Expert Interviews

Dr Martin Maron

What are the current conventional pharmacological treatments for HCM and what unmet needs remain?
Duration: 18:32

Dr Michelle Michels

What therapeutic classes are emerging for HCM and what is the latest evidence for their use?
Duration: 12:43

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Learning Objectives & Overview

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Learning Objectives

After watching this activity, participants should be better able to:

  • Evaluate the current conventional pharmacological treatments for oHCM and nHCM and their application in different patient types
  • Identify the current unmet treatment needs for patients with oHCM or nHCM and the emerging therapeutic classes that may address these gaps in care
  • Interpret the latest data for cardiac myosin inhibitors and other emerging treatment classes for HCM and their potential implications for current and future clinical practice

Overview

In this activity, two experts provide insights on contemporary care for obstructive and nonobstructive HCM. They highlight the unmet needs of patients with HCM and discuss the evidence base for cardiac myosin inhibitors and other emerging therapeutic classes.

This activity is jointly provided by Partners for Advancing Clinical Education (Partners) and touchIME.

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Target Audience 

This activity has been designed to meet the educational needs of cardiologists, cardiology nurse specialists, electrophysiologists, heart failure specialists, interventional cardiologists and pharmacists involved in the management of HCM.

Disclosures 

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculty

Dr Martin Maron discloses Advisory board/panel fees from Cytokinetics Inc. Consultancy fees from Edgewise Therapeutics and Imbria Pharmaceuticals.

Dr Michelle Michels discloses Advisory board/panel fees from Bayer, Bristol Myers Squibb and Novo Nordisk. Consultancy fees from Alnylam, Bristol Myers Squibb, Cytokinetics Inc. and Kardigan. Grants/research support from Bristol Myers Squibb.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and touchIME. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


Physician Continuing Education

Partners designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development 

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 0.75 contact hours.

Pharmacy Continuing Education          

Partners designates this continuing education activity for 0.75 contact hour(s) (0.75 CEUs) of the Accreditation Council for Pharmacy Education.

(Universal Activity Number – JA4008073-9999-25-336-H01-P)

Type of Activity: Knowledge

For Pharmacists: Upon successfully completing the post-test with a score of 75% or better (if applicable) and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

For additional information about the accreditation of this activity, please visit https://partnersed.com

Date of original release: 20 October 2025. Date credits expire: 20 October 2026.

Estimated time to complete the activity: 46 minutes

EBAC® Accreditation

touchIME is an EBAC® accredited provider since 2023.

This programme is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) for 46 minutes of effective education time.

EBAC® holds an agreement on mutual recognition of substantive equivalency with the US Accreditation Council for CME (ACCME) and the Royal College of Physicians and Surgeons of Canada, respectively.

Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) and the American Medical Association, physicians may convert EBAC® External CME credits to AMA PRA Category 1 Credit™. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other health care professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 Credit™.

EBAC® is a member of the International Academy for CPD Accreditation (IACPDA) and a partner member of the International Association of Medical Regulatory Authorities (IAMRA).

Faculty Disclosure Statement / Conflict of Interest Policy

In compliance with EBAC® guidelines, all speakers/chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event have been mitigated and declared to the audience prior to the CME activities.

Requirements for Successful Completion

Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed.

Date of original release: 20 October 2025. Date credits expire: 20 October 2027.

Time to complete: 46 minutes

If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org

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Expert Interviews

Dr Martin Maron

What are the current conventional pharmacological treatments for HCM and what unmet needs remain?
Duration: 18:32

Dr Michelle Michels

What therapeutic classes are emerging for HCM and what is the latest evidence for their use?
Duration: 12:43

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This activity is for healthcare professionals outside of the UK.

This activity is supported by an independent medical educational grant from Cytokinetics, Inc.

Jointly provided by Partners for Advancing Clinical Education and touchIME.
touchIME is an EBAC® accredited provider.

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This activity is supported by:

An independent medical educational grant from Cytokinetics, Inc.

Jointly provided by Partners for Advancing Clinical Education and touchIME.
touchIME is an EBAC® accredited provider.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

EBAC® Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed.

Date of original release: 20 October 2025. Date credits expire: 20 October 2026.

Time to complete: 46 minutes.

If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org.

AMA PRA Category 1 Credit ™ expires: October 20, 2026
EBAC® credits expire: October 20, 2027

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