Panichella Giorgia, Aimo Alberto, Castiglione Vincenzo, Vergaro Giuseppe, Emdin Michele
Department of Experimental and Clinical Medicine, University of Florence Florence, Italy.
Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna Pisa, Italy.
Card Fail Rev. 2025 Jul 17;11:e15. doi: 10.15420/cfr.2024.33. eCollection 2025.
Heart failure (HF) and cardiac amyloidosis (CA) are significant clinical challenges, with evolving epidemiological patterns reshaping the understanding of these conditions. Traditionally linked with HF with preserved ejection fraction, CA is increasingly recognised for its specific characteristics, including a considerable subset of patients presenting with reduced left ventricular ejection fraction. This review explores how the neurohormonal activation observed in CA impacts on disease progression and management strategies. Historically, neurohormonal antagonists were considered contraindicated in CA owing to concerns about autonomic dysfunction and chronotropic incompetence. However, recent evidence suggests a paradigm shift, indicating that such agents may offer therapeutic benefits even in these patients. By examining these developments, this review provides a comprehensive overview of current therapeutic approaches, the role of neurohormonal modulation and the need for personalised care strategies to address the complexities of HF in the context of CA.
心力衰竭（HF）和心脏淀粉样变性（CA）是重大的临床挑战，不断演变的流行病学模式正在重塑对这些病症的认识。CA传统上与射血分数保留的心力衰竭相关联，其特定特征越来越受到认可，包括相当一部分左心室射血分数降低的患者。本综述探讨了CA中观察到的神经激素激活如何影响疾病进展和管理策略。从历史上看，由于担心自主神经功能障碍和变时性功能不全，神经激素拮抗剂被认为在CA中是禁忌的。然而，最近的证据表明了一种范式转变，表明即使在这些患者中，此类药物也可能带来治疗益处。通过研究这些进展，本综述全面概述了当前的治疗方法、神经激素调节的作用以及在CA背景下应对HF复杂性所需的个性化护理策略。
