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Mineralocorticoid Receptor Antagonists Therapy in Transthyretin Amyloid Cardiomyopathy: A Propensity-Matched Cohort Study
Session:
Sessão de Posters 11 - Dos digitálicos aos diuréticos no espectro da insuficiência cardíaca
Speaker:
Emídio Mata
Congress:
CPC 2026
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Emídio Mata; Ana Marta Pinto; Luísa Pinheiro; Margarida Castro; Bárbara Lage Garcia; Tamara Pereira; Filipa Cordeiro; Olga Azevedo; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Background:</span></strong><span style="font-size:11.0pt"> Evidence for mineralocorticoid receptor antagonists (MRA) in heart failure (HF) secondary to transthyretin amyloid cardiomyopathy (ATTR-CM) is limited.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Aim:</span></strong><span style="font-size:11.0pt"> Evaluate the impact of MRA on clinical outcomes in ATTR-CM.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Methods:</span></strong><span style="font-size:11.0pt"> Single-center, retrospective cohort of consecutive patients with confirmed ATTR-CM (2014–2023; n=111). Patients were categorized as MRA-treated or untreated. Propensity score (PS) matching used 11 clinical covariates, yielding 26 matched pairs (n=52). The primary outcome was all-cause mortality; secondary outcomes included heart failure hospitalization (HFH) and a composite of mortality and HFH. Survival was analyzed using Kaplan–Meier estimates and Cox regression, with treatment modeled both at baseline and as a time-varying covariate to account for immortal time bias.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Results: </span></strong><span style="font-size:11.0pt">In the PS-matched cohort (mean age 81.0±4.6 years, 61.5% male), MRA therapy was not associated with a reduction in all-cause mortality (HR=0.71 [0.28–1.81] <em>p</em>=0.48), over a median follow-up of 23 months (IQR: 16–41.25). In the overall (unmatched) cohort, MRA therapy was also not associated with mortality (HR=0.93 [0.50–1.72] <em>p</em>=0.82). In time-varying Cox models, MRA treatment remained neutral both unadjusted (HR=0.96 [0.44–2.08] <em>p</em>=0.92) and after multivariable adjustment for age, sex, comorbidities, and concurrent HF therapies (HR=1.35 [0.62–2.95] <em>p</em>=0.45).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt">Similarly, no significant association was observed between MRA therapy and HF hospitalization. In the PS-matched cohort, the HR for HFH was 0.71 [0.28–1.81] (<em>p</em>=0.48), consistent with findings in the unmatched cohort (HR=0.93 [0.50–1.72] <em>p</em>=0.82). In time-varying analyses, MRA remained neutral both unadjusted (HR=0.96 [0.44–2.08] <em>p</em>=0.92) and adjusted (HR=1.35 [0.62–2.95] <em>p</em>=0.45).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt">The composite endpoint of all-cause mortality or HF hospitalization was likewise unaffected by MRA use (PS-matched HR=0.71[0.28–1.81] <em>p</em>=0.48), with consistent null findings in time-varying unadjusted and adjusted analyses.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Conclusions:</span></strong><span style="font-size:11.0pt"> In this PS-matched observational cohort of ATTR-CM, MRA therapy was not associated with improved survival, fewer HFH, or lower composite event rates. Findings were consistent across baseline and time-varying analyses, suggesting no apparent benefit of MRA therapy in this population. Prospective, adequately powered studies are warranted to clarify the role of MRA in ATTR-CM.</span></span></span></p>
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