Cardiology tips updates

🫀 FDA-Approved Therapies in ATTR Amyloidosis

🔹 ATTR Cardiomyopathy (Heart):
• Tafamidis
• Acoramidis
• Vutrisiran

🔹 ATTR Polyneuropathy (Nerve):
• Patisiran
• Vutrisiran
• Inotersen
• Eplontersen

📌 Key Concept:
• Stabilizers → prevent TTR misfolding
• Gene silencers → reduce TTR production

👉 ATTR is now a treatable disease with multiple disease-modifying options.

Review ;
🟣 FDA-Approved for ATTR Polyneuropathy

✔️ Patisiran (Onpattro)
• FDA approved 2018
• First RNAi therapy for hATTR-PN 

✔️ Vutrisiran (Amvuttra)
• FDA approved 2022 for hATTR-PN 
• Later expanded to cardiomyopathy (2025) 

✔️ Inotersen (Tegsedi)
• FDA approved 2018 for hATTR-PN 

✔️ Eplontersen (Wainua)
• FDA approved Dec 2023 for hATTR-PN

Know the treatment of ATTR Amyloidosis ( HEART VS. NERVE)

DO YOU KNOW THIS ! Journal review;

📊 Aficamten vs Metoprolol in Obstructive HCM (NEJM 2025)

🔬 Why this matters:
Beta-blockers have been first-line therapy for symptomatic obstructive hypertrophic cardiomyopathy (HCM), but strong comparative evidence has been limited. This trial directly compares aficamten (cardiac myosin inhibitor) vs metoprolol.

👥 Study Design:
• Phase 3, randomized, double-blind, head-to-head
• 175 patients with symptomatic obstructive HCM
• 24-week follow-up
• Primary endpoint: change in peak VO₂

💊 Intervention:
• Aficamten (5–20 mg)
• Metoprolol (50–200 mg)

📈 Key Results:
• Aficamten significantly IMPROVED exercise capacity (↑ peak VO₂)
• Mean difference: +2.3 mL/kg/min (p < 0.001)
• Metoprolol showed a decline in peak VO₂
• Adverse events: similar between groups

⚠️ Limitations:
• Short duration (24 weeks)
• Long-term outcomes unknown
• Beta-blocker dosing strategy may vary in practice

🏁 Bottom Line:
👉 Aficamten monotherapy is SUPERIOR to metoprolol in improving functional capacity in symptomatic obstructive HCM, with comparable safety.

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SGLT2 inhibitors show strong heart benefits in cancer patients undergoing chemotherapy, reducing deaths and heart issues, supporting their use in cardio-oncology, especially for high-risk patients.

-Oncology

SGLT-2 Inhibitors in Prevention of Chemotherapy-Induced Cardiotoxicity: Systematic Review and Meta-analysis AbstractBackground. Chemotherapy is associated with significant cardiotoxicity. Although other guideline directed medications for heart failure are effecti

ATTR vs AL Amyloidosis — Quick Clinical Basics

AL amyloidosis
• Caused by monoclonal light chains
• κ or λ only (λ predominates ~70–75%)
• Heavy chains do NOT form cardiac amyloid
• Must be excluded first with serum & urine immunofixation + free light chains

ATTR amyloidosis
• Caused by misfolded transthyretin (TTR)
• Not an immunoglobulin disease
• Can be diagnosed non-invasively once AL is excluded
• Targeted therapies now available

Key rule

Exclude AL first. Then evaluate for ATTR.

Welcome to Cardiology Tips Updates

This page is dedicated to evidence-based cardiology education, with a focus on:
• ECG interpretation
• Echocardiography
• Cardiac imaging & clinical pearls

Content is designed for clinicians, trainees, and learners worldwide, emphasizing practical understanding and exam-relevant concepts.

📌 Posts are educational in nature and intended to support learning and discussion.
📌 Clinical decisions should always follow local guidelines and physician judgment.

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