Neurohormonal therapies at baseline and follow-up and survival in wild-type transthyretin cardiac amyloidosis
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Transthyretin cardiac amyloidosis (ATTR-CA) typically manifests with heart failure. Discontinuing beta-blockers and avoiding angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) in patients with ATTR-CA has been recommended. METHODS: We investigated the prescription of neurohormonal therapies and their relationship with all-cause mortality in a multicenter cohort. RESULTS: Patients (n = 926) had a median age of 79 years (interquartile range 74-83), 90% were men, 17% had a left ventricular ejection fraction (LVEF) 40% or less, and 27% were in New York Heart Association (NYHA) class III/IV. At diagnosis, 60% of patients were on beta-blockers, 58% on ACEi/ARB/ARNI, and 35% on MRA. Patients on beta-blockers had more often NYHA class III/IV, a greater burden of comorbidities, and lower LVEF, and those on ACEi/ARB/ARNI had more comorbidities. Nonetheless, the survival of patients on beta-blockers or ACEi/ARB/ARNI was not significantly shorter over a 2.5-year follow-up (1.6-3.8) (P = 0.577 and P = 0.977, respectively), and patients on both drugs did not have a worse outcome than those not receiving any neurohormonal drug (P = 0.575). During the entire follow-up, the number of neurohormonal drugs remained unchanged in 54%, decreased in 27%, and increased in 19%. Patients with a number of neurohormonal drugs either unchanged or increased had a lower risk of mortality (odds ratio 0.71, 95% confidence interval 0.53-0.95, P = 0.023). CONCLUSION: ATTRwt-CA patients on beta-blockers or ACEi/ARB/ARNI at diagnosis did not have a shorter survival. Beta-blockers were discontinued less often than were ACEi/ARB/ARNI. There was no sign of better outcomes in patients discontinuing these therapies, or worse outcomes in those starting them.
Authors: Alberto Aimo, Paolo Milani, Giacomo Tini, Giuseppe Vergaro, Marco Basset, Beatrice Musumeci, Mattia Zampieri, Irene Ruotolo, Francesca Fabris, Andrea Foli, Alessia Argirò, Carlotta Mazzoni, Maria Alessandra Schiavo, Simone Longhi, Giulia Saturi, Ludovica De Fazio, Guerino Giuseppe Varrà, Matteo Serenelli, Gioele Fabbri, Laura De Michieli, Giuseppe Palmiero, Giuseppe Ciliberti, Samuela Carigi, Margherita Zanoletti, Giulia Elena Mandoli, Giulia Ricci Lucchi, Giorgia Panichella, Valeria Rella, Enrico Monti, Elisa Gardini, Michela Bartolotti, Lia Crotti, Elisa Merli, Roberta Mussinelli, Pier Filippo Vianello, Matteo Cameli, Francesca Marzo, Federico Guerra, Giuseppe Limongelli, Alberto Cipriani, Stefano Perlini, Laura Obici, Federico Perfetto, Emanuele Barbato, Italo Porto, Gianfranco Sinagra, Marco Merlo, Elena Biagini, Francesco Cappelli, Giovanni Palladini, Michele Emdin, Marco Canepa
Institutions: Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, University of Pavia, Policlinico San Matteo Fondazione, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Careggi, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, ERN GUARD-Heart, University of Ferrara, Azienda Unità Sanitaria Locale Della Romagna, University of Padua, Azienda Ospedale - Università Padova, University of Campania "Luigi Vanvitelli", Ospedale Monaldi, Marche Polytechnic University, Ospedale Infermi di Rimini, Ospedale Policlinico San Martino, University of Siena, IRCCS Istituto Auxologico Italiano, Azienda-Unita' Sanitaria Locale Di Cesena, University of Milano-Bicocca, Ospedale per gli Infermi, University of Trieste, Azienda sanitaria universitaria Giuliano Isontina, University of Genoa
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W4416705807