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Guideline-Directed Medical Therapy for Heart Failure in Transthyretin Amyloid Cardiomyopathy
Journal article   Peer reviewed

Guideline-Directed Medical Therapy for Heart Failure in Transthyretin Amyloid Cardiomyopathy

Stephanie Kristina Schwarting, Thomas Bieber, Daniel R. Davies, Fabian Aus Dem Siepen, Julian Schwarting, Ulrich Grabmaier, Steffen Massberg, Mathew S. Maurer and Stefan Kaeaeb
Circulation. Heart failure, v 18(4), 011796
Apr 2025
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.124.011796
PMID: 39963776

Abstract

Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Science & Technology
Cardiac amyloidosis is an underdiagnosed cause of infiltrative cardiomyopathy, leading to heart failure across the spectrum of ejection fractions. Although there are approved disease-modulating therapies for the transthyretin subtype (transthyretin amyloid cardiomyopathy [ATTR-CM]), the role of heart failure medications remains uncertain and challenging in clinical practice. Their effects on clinical outcomes, such as mortality and hospitalization, are unknown for ATTR-CM. This review aims to explore the use of these medications in ATTR-CM, considering the disease's stage and patient-specific issues, such as fluid homeostasis, autonomic dysfunction, conduction disorders, low and fixed stroke volumes, and decreased functional capacity. As our understanding of this condition deepens, it is important to reassess the impact of contemporary heart failure medication in ATTR-CM. Finally, the relevance of guideline recommendations for heart failure drugs based on left ventricular ejection fraction should be reconsidered in the context of ATTR-CM.

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