Rationale for contemporary domestic and international approaches to managing patients with ATTR-amyloid cardiomyopathy

ATTR amyloid cardiomyopathy (AC) is a complex and under-recognized condition that has been attracting increasing attention from the medical community in recent years. This is due to a deeper understanding of the disease’s pathogenesis, an expansion of data on its clinical presentation, and the emergence of more accurate diagnostic tools. Nevertheless, AC remains one of the causes of chronic heart failure (CHF) with preserved left ventricular ejection fraction (LVEF), especially prevalent among elderly patients. Moreover, one of the main challenges is late diagnosis, caused by both the non-specificity of symptoms and insufficient vigilance among physicians. As a consequence, this leads to disease progression and a poorer prognosis. Therefore, timely identification of both cardiac and extracardiac symptoms of ATTR amyloidosis is crucial for improving diagnostic accuracy and initiating appropriate therapy. The treatment of amyloidosis includes pathogenetic (anti-amyloid) and symptomatic therapies. Currently, tafamidis is the first drug used for the treatment of ATTR amyloidosis and is recommended for patients with both hereditary and “wild-type” forms of the disease. Amyloid cardiomyopathy is an interdisciplinary problem that requires heightened awareness not only from cardiologists but also from general practitioners and specialists in related fields. The optimization of diagnostic algorithms and the implementation of innovative therapeutic approaches are key objectives for reducing the time to diagnosis and initiating timely treatment. The recommendations discussed in this article can serve as a basis for improving the quality of care provided to patients with AC.