Stimulation of Contractility in Systolic Heart Failure

This editorial discusses the GALACTIC-HF trial results evaluating omecamtiv mecarbil, a cardiac myosin activator that enhances myocardial contractility without increasing oxygen consumption, in patients with systolic heart failure (ejection fraction ≤35%). The trial involved 8232 participants randomized to omecamtiv mecarbil or placebo alongside guideline-directed therapy. Omecamtiv mecarbil produced a modest 8% relative risk reduction in the primary composite outcome of cardiovascular death or heart failure events (P=0.03), driven mainly by benefit in patients with ejection fraction below 28%. There was no effect on cardiovascular mortality, all-cause death, or hospitalizations. No increase in arrhythmias or ischemia was observed despite small troponin elevations. Quality-of-life scores improved slightly in hospitalized patients, though not significantly. The editorial concludes that omecamtiv mecarbil may offer limited benefit, particularly for severely reduced ejection fraction, but recommends prioritizing more established therapies such as angiotensin receptor–neprilysin inhibitors and SGLT2 inhibitors. Wider adoption awaits further data and clarification of clinical utility

This editorial discusses the GALACTIC-HF trial results evaluating omecamtiv mecarbil, a cardiac myosin activator that enhances myocardial contractility without increasing oxygen consumption, in patients with systolic heart failure (ejection fraction ≤35%). The trial involved 8232 participants randomized to omecamtiv mecarbil or placebo alongside guideline-directed therapy. Omecamtiv mecarbil produced a modest 8% relative risk reduction in the primary composite outcome of cardiovascular death or heart failure events (P=0.03), driven mainly by benefit in patients with ejection fraction below 28%. There was no effect on cardiovascular mortality, all-cause death, or hospitalizations. No increase in arrhythmias or ischemia was observed despite small troponin elevations. Quality-of-life scores improved slightly in hospitalized patients, though not significantly. The editorial concludes that omecamtiv mecarbil may offer limited benefit, particularly for severely reduced ejection fraction, but recommends prioritizing more established therapies such as angiotensin receptor–neprilysin inhibitors and SGLT2 inhibitors. Wider adoption awaits further data and clarification of clinical utility