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Navigating Tafamidis Outcomes Across Different Disease Severities in ATTR-CM
Session:
SESSÃO DE POSTERS 06 - AMILOIDOSE CARDÍACA
Speaker:
Miguel Azaredo Raposo
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Miguel Azaredo Raposo; Catarina Gregório; Ana Abrantes; Diogo Ferreira; Catarina Campos; Isabel Conceição; Catarina Sousa; Fausto J. Pinto; Dulce Brito; João Agostinho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: In the ATTR-ACT trial, tafamidis 61mg was proved to be beneficial in patients with confirmed TTR amyloid cardiomyopathy (ATTR-CM) and NT-proBNP levels ≥600 pg/mL, emphasizing the pivotal role of NT-proBNP as a prognostic marker. This threshold remains a widely adopted prescribing criterion in many healthcare centers.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To evaluate the impact of tafamidis 61mg on clinical outcomes in ATTR-CM patients with NT-proBNP levels < 600 pg/mL and ≥600 pg/mL.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Single-center retrospective study of ATTR-CM patients receiving tafamidis 61mg, categorized into two groups based on NT-proBNP levels: <600 pg/mL and ≥600 pg/mL. Demographic characteristics and echocardiographic parameters were collected. Continuous variables were compared using the Student’s T-test, and categorical variables were compared using Chi-square tests.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Among the 98 ATTR-CM patients (79 males, mean age: 78.6±10.7 years), 25 had NTproBNP levels <600 pg/mL, while 73 had NTproBNP levels ≥600 pg/mL at the time of diagnosis. All patients in the NTproBNP <600 pg/mL group had hereditary ATTR and classified as NYHA I (25 vs. 3 patients in the NTproBNP ≥600 pg/mL group; p<0.001), had an earlier symptom onset age (63.2±3.4 vs. 77.4±8.5; p<0.001), with initial manifestations including polyneuropathy, gastrointestinal or genitourinary symptoms, compared to the predominance of heart failure symptoms in the NTproBNP ≥600 pg/mL group. These patients exhibited lower troponin T (30.8±7.4 vs. 55.7±5.6;p<0.001), milder left ventricular wall thickness (IVS: 13.7±0.7 vs. 17.4±0.4 mm; p<0.001), better right ventricular function (TAPSE: 21.4±0.7 vs. 18.2±0.6 mm; p<0.001), and lower filling pressures (E/e': 10.4±0.9 vs. 17.2±1.1, p<0.001). Fewer patients in this group were on furosemide therapy (6 vs. 39; p<0.001).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">During the 24.9±2.1 months follow-up, the NTproBNP <600 pg/mL group appeared to benefit from the initiation of the drug, with a reduction in left ventricular mass (T0:119.1±10.8 vs. T1:95.8±4.3 g/m2; p=0.023). </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff">No statistically significant differences were observed in NTproBNP or troponin T levels during the follow-up.</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> However, a decline in functional capacity was noted (NYHA I 14, NYHA II 9, NYHA III 1 patients). Despite the progression in functional class, patients in this group did not experience cardiovascular-related hospitalizations or cardiovascular death events during the follow-up period (p=0.056).</span></span></span></p> <p style="text-align:justify"><br /> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: The use of tafamidis in patients with NTproBNP <600 pg/mL appears to have a protective effect on disease progression suggesting that this cut-off should not be used as a factor for disease modifying treatment exclusion.</span></span></span></p> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div id="accel-snackbar" style="left:50%; top:50px; transform:translate(-50%, 0px)"> </div>
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