Heart failure & cardiomyopathiesCohort study
Insights into the renin–angiotensin–aldosterone system in transthyretin amyloid cardiomyopathy
- Prospective cohort study
Authors' conclusion
ATTR-CM patients exhibit distinct RAAS profiles, with increased ACE2 activity and a shift toward the alternative RAAS axis in more advanced disease. Higher ACE2 activity is associated with higher NT-proBNP, biventricular dysfunction and adverse cardiac outcomes
Study context
- Population
- Patients with transthyretin amyloid cardiomyopathy (ATTR-CM)
- Participants
- 137 patients
- Exposure
- ACE2 activity above vs below median
- Outcome
- Composite of:
- HF hospitalization
- Cardiac death
- Follow-up
- Median 1.6 years
Main finding
As reported in the abstract
Patients with the composite endpoint
49 (36%)
Observational data: associations, not effects.
Further findings
ACE2 activity and alternative renin-angiotensin-aldosterone system (RAAS) peptides in patients with vs without adverse cardiac events
- Higher ACE2 activity with adverse cardiac events
- P < 0.001
- Higher angiotensin 1-7 with adverse cardiac events
- P = 0.007
- Higher angiotensin 1-5 with adverse cardiac events
- P < 0.001
ACE2 activity vs N-terminal pro brain natriuretic peptide (NT-proBNP) and echocardiography
- Higher ACE2 activity associated with higher NT-proBNP
- P < 0.001
- Higher ACE2 activity associated with more advanced echocardiographic markers of biventricular dysfunction
RAAS inhibitor use
- ACEi
- 21.2%
- ARBs
- 34.3%
- ARNIs
- 7.3%
- None
- 26.0%
- RAAS profiles consistent with expected effects of the respective RAAS inhibitors
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Summarised from the published abstract; every number is checked against it