Abstract 4144360: Neurohormonal therapies at baseline and follow-up and survival in patients with wild-type transthyretin cardiac amyloidosis

Background: Transthyretin cardiac amyloidosis (ATTR-CA) typically manifests with heart failure (HF). 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%, 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 had not 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). Conclusions: 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 ACEi/ARB/ARNI. There was no sign of better outcomes in patients discontinuing these therapies, or worse outcomes in those starting them.

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Journal
Circulation
Published
2024-11-12
DOI
https://doi.org/10.1161/circ.150.suppl_1.4144360
Primary Topic
Amyloidosis: Diagnosis, Treatment, Outcomes
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article
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article

Abstract 4144360: Neurohormonal therapies at baseline and follow-up and survival in patients with wild-type transthyretin cardiac amyloidosis

Matteo Serenelli, Stefano Perlini, Andrea Foli, Alberto Cipriani et al.
Circulation
Amyloidosis: Diagnosis, Treatment, Outcomes
article

Abstract 4144360: Neurohormonal therapies at baseline and follow-up and survival in patients with wild-type transthyretin cardiac amyloidosis

Matteo Serenelli, Stefano Perlini, Andrea Foli, Alberto Cipriani, Simone Longhi, Francesca Marzo, Giuseppe Ciliberti, Beatrice Musumeci, Roberta Mussinelli, Gianfranco Sinagra, Laura De Michieli, Carlotta Mazzoni, Giuseppe Vergaro, Giulia Elena Mandoli, Angelo Giuseppe Caponetti, Federico Perfetto, Mattia Zampieri, Christian Gagliardi, Giuseppe Limongelli, Valeria Rella, Michele Emdin, Marco Merlo, Samuela Carigi, Giacomo Tini, Laura Piera Obici, Marco Canepa, Elena Biagini, Francesco Cappelli, Giuseppe Palmiero, Giovanni O. Palladini, Paolo Milani, Alberto Aimo, Giulia Saturi, Matteo Cameli, F Fabris, Gioele Fabbri
article en

Abstract

Background: Transthyretin cardiac amyloidosis (ATTR-CA) typically manifests with heart failure (HF). 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%, 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 had not 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). Conclusions: 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 ACEi/ARB/ARNI. There was no sign of better outcomes in patients discontinuing these therapies, or worse outcomes in those starting them.

CirculationVol. 150(Suppl_1)
University of Siena (IT), University of Padua (IT), University of Trieste (IT), University of Ferrara (IT), Ospedali Riuniti di Ancona (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Ospedale Infermi di Rimini (IT), IRCCS Istituto Auxologico Italiano (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Fondazione Toscana Gabriele Monasterio (IT), University of Naples Federico II (IT), Sapienza University of Rome (IT), University of Bologna (IT)
Good health and well-being
Openalex Percentile: Top 82%
Amyloidosis: Diagnosis, Treatment, Outcomes
DOISourceOpenAlex
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