Kourek Christos, Briasoulis Alexandros, Magouliotis Dimitrios E, Georgoulias Panagiotis, Giamouzis Grigorios, Triposkiadis Filippos, Skoularigis John, Xanthopoulos Andrew
Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1 Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece.
Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece.
World J Cardiol. 2024 Jul 26;16(7):370-379. doi: 10.4330/wjc.v16.i7.370.
Cardiac amyloidosis is a progressive disease characterized by the buildup of amyloid fibrils in the extracellular space of the heart. It is divided in 2 main types, immunoglobulin light chain amyloidosis and transthyretin amyloidosis (ATTR), and ATTR amyloidosis is further divided in 2 subtypes, non-hereditary wild type ATTR and hereditary mutant variant amyloidosis. Incidence and prevalence of ATTR cardiac amyloidosis is increasing over the last years due to the improvements in diagnostic methods. Survival rates are improving due to the development of novel therapeutic strategies. Tafamidis is the only disease-modifying approved therapy in ATTR amyloidosis so far. However, the most recent advances in medical therapies have added more options with the potential to become part of the therapeutic armamentarium of the disease. Agents including acoramidis, eplontersen, vutrisiran, patisiran and anti-monoclonal antibody NI006 are being investigated on cardiac function in large, multicenter controlled trials which are expected to be completed within the next 2-3 years, providing promising results in patients with ATTR cardiac amyloidosis. However, further and ongoing research is required in order to improve diagnostic methods that could provide an early diagnosis, as well as survival and quality of life of these patients.
心脏淀粉样变性是一种进行性疾病,其特征是心脏细胞外空间中淀粉样纤维的堆积。它主要分为两种类型,免疫球蛋白轻链淀粉样变性和转甲状腺素蛋白淀粉样变性(ATTR),而ATTR淀粉样变性又进一步分为两个亚型,非遗传性野生型ATTR和遗传性突变型淀粉样变性。由于诊断方法的改进,近年来ATTR心脏淀粉样变性的发病率和患病率正在上升。由于新型治疗策略的发展,生存率正在提高。塔法米迪斯是迄今为止ATTR淀粉样变性中唯一获批的疾病修饰疗法。然而,医学治疗的最新进展增加了更多选择,有可能成为该疾病治疗手段的一部分。包括阿考米迪斯、依普仑赛、维曲西泮、帕替西兰和抗单克隆抗体NI006在内的药物正在大型多中心对照试验中研究其对心脏功能的影响,这些试验预计将在未来2至3年内完成,有望为ATTR心脏淀粉样变性患者带来良好结果。然而,为了改进能够提供早期诊断的诊断方法,以及提高这些患者的生存率和生活质量,还需要进一步的持续研究。