New saviour for an old problem: Omecamtiv mecarbil for systolic heart failure

In the GALACTIC-HF trial, Teerlink and coauthors compared the selective cardiac myosin activator omecamtiv mecarbil (OM) in heart failure patients with reduced ejection fraction (HFrEF).¹ Omecamtiv activates the sarcomere proteins directly, resulting in an increased cardiac contractility and a prolonged systolic ejection time.² Presently, drugs such as ACE inhibitors, angiotensin receptor blockers (ARBs), beta blockers (BBs), angiotensin receptor neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA), and sodium-dependent glucose cotransporter 2 (SGLT2) inhibitors are approved for HFrEF. For symptomatic relief, diuretics and digoxin are used. Cardiac resynchronisation treatment and cardiac transplantation are nonpharmacological approaches approved for patients resistant to drug therapy. Omecamtiv is a new drug approved as a fast track by the United States Food and Drug Administration (USFDA) in May 2020.³ Being an orally active drug and acting directly on the cardiac myocytes, OM shows promising results for HFrEF patients.