Table 9.2. Omecamtiv mercabil in the treatment of HFrEF patients.

Notes	Comment	Table 2018	Ref.
Omecamtiv mecarbil in patients with acute or chronic HFrEF.	POTENTIAL: The observations described herein reflect data from recent studies on this new class of drug. However, it has not been approved by Anvisa for use in Brazil yet.	New	128–131
Omecamtiv mecarbil selectively binds to cardiac myosin resulting in activation and increase in rate of ATP hydrolysis, and the transition of myosin to the strongly actin-bound force-generating state, improving impaired ventricular contraction in cases of HFrEF. Its mechanism of action is different from mechanisms of the current triple therapy, which inhibits neurohormonal stimulation. Mechanistic studies such as the ATOMIC-AHF (Acute Treatment with Omecamtiv Mecarbil to Increase Contractility in Acute Heart Failure)128 and COSMIC-HF (Chronic Oral Study of Myosin Activation to Increase Contractility in Heart Failure)129 trials, showed that the medication improved contractility, ejection fraction, ejected volume and cardiac output, in addition to other parameters of improved cardiac function. Studies show it promotes decreases in NT-proBNP levels. High troponin levels were also identified without clinical changes in the studies. The Atomic-AHF trial, however, with acute HF patients, found no reduction in dyspnea among patients in the treatment group. In the recently-published GALACTIC-HF (Cardiac Myosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure) randomized controlled trial, patients with HFrEF who received omecantiv mecarbil had lower risk of composite outcomes from an HF event (defined as hospitalization or unplanned visits due to worsening HF) or cardiovascular death than those who received a placebo.130,131 However, when assessed individually, there was no difference in the following secondary outcomes: all-cause mortality, cardiovascular death, first hospitalization for HF, or changes in the Kansas City Cardiomyopathy Questionnaire quality of life score.

HF: heart failure; HFrEF: heart failure with reduced ejection fraction.