In patients with heart failure in the outpatient clinic, it is standard of care to monitor the clinical status with clinical investigation, to prescribe heart failure medications and to adjust doses of medications, such as diuretics. A similar path is now opened for patients with transthyretin amyloid cardiomyopathy (ATTR-CM), with medications consisting of TTR silencing and stabilising agents, but also heart failure medications and diuretics, with remaining questions how to monitor in the best possible way.1 The present paper by Bampatsias et al addresses the question of whether natriuretic peptide measurements and diuretic doses may be of particular interest for monitoring in patients with ATTR-CM after having started tafamidis treatment for 1 year. The answer is yes, as both parameters predict mortality and cardiovascular hospitalisations.2
The present study is not a validation study but does follow a previous study that demonstrated similar findings for 1598 patients with ATTR-CM, mainly from the period before disease-modifying treatment.3 This earlier study of Ioannou et al established criteria for N-terminal pro B-type natriuretic peptide (NT-proBNP) increases (>700 ng/L and >30% increase) and for diuretic dose increases (any increase or initiation) that occur in the first year after baseline. The discriminatory value of the two parameters together had an area under the curve (AUC) of 0.61.3 The present study of Bampatsias et al differs from the previous study by Ioannou et al in that (1) it is a first study in …
