Aficamten for Obstructive Hypertrophic Cardiomyopathy

To the Editor: In the SEQUOIA-HCM (Safety, Efficacy, and Quantitative Understanding of Obstruction Impact of Aficamten in HCM [hypertrophic cardiomyopathy]) trial, Maron et al. (May 30 issue)(1) found that treatment with aficamten significantly improved exercise capacity, reduced left ventricular outflow tract gradients, and led to favorable patient-reported outcomes as compared with placebo. However, a critical limitation of the trial is the underrepresentation of Black patients, with only three Black participants in the aficamten group and none in the placebo group. The EXPLORER-HCM trial, which evaluated mavacamten for the treatment of symptomatic obstructive HCM, also had low enrollment of Black patients.(2) . . .