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Heart Failure Management in Cardiac Amyloidosis: Towards a Paradigm Shift

Giorgia Panichella1, Alberto Aimo2,3, Vincenzo Castiglione2,3

  • 1Department of Experimental and Clinical Medicine, University of Florence Florence, Italy.

Cardiac Failure Review
|July 31, 2025
PubMed

Insights

Cardiac amyloidosis (CA) and heart failure (HF) management is evolving. Neurohormonal antagonists, once contraindicated, may now benefit CA patients, shifting treatment paradigms for improved outcomes.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Biomedical Science

Background:

  • Heart failure (HF) and cardiac amyloidosis (CA) present complex clinical challenges with changing epidemiology.
  • CA is increasingly recognized beyond HF with preserved ejection fraction, affecting patients with reduced ejection fraction too.

Purpose of the Study:

  • To review the impact of neurohormonal activation in CA on disease progression and management.
  • To explore the evolving role of neurohormonal antagonists in CA treatment.
  • To provide an overview of current therapeutic strategies and personalized care for HF in CA.

Main Methods:

  • Literature review of current therapeutic approaches for HF in CA.
  • Analysis of the role of neurohormonal activation and modulation in CA.
  • Examination of recent evidence regarding neurohormonal antagonists in CA patients.

Main Results:

  • CA presents with diverse left ventricular ejection fraction profiles, not limited to preserved function.
  • Historically contraindicated neurohormonal antagonists show potential therapeutic benefits in CA.
  • Personalized care strategies are crucial for managing HF complexities in CA.

Conclusions:

  • The understanding of CA and its impact on HF is evolving.
  • Neurohormonal modulation represents a key area for therapeutic advancement in CA.
  • A paradigm shift in treatment strategies, including the use of neurohormonal antagonists, is emerging for CA patients with HF.

Keywords:
Heart failurecardiac amyloidosisneurohormonalβ-blockers

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