Case Report | DOI: https://doi.org/10.31579/2692-9759/200
St Francis Emory Medical Center, Columbus GA.
*Corresponding Author: Sriharsha Kanuri, St Francis Emory Medical Center, Columbus GA.
Citation: Sriharsha Kanuri, Alissa KC, Brain Cho, Vikramjit Chhokar, (2026), Disease Modifying Therapeutics Prevalently Available for Transthyretin (ATTR) Cardiac Amyloidosis: Avenues for Attenuating Disease Progression and Improving Functional Quality of Life, Cardiology Research and Reports, 8(4); DOI:10.31579/2692-9759/200
Copyright: © 2026, Sriharsha Kanuri. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 24 August 2026 | Accepted: 04 September 2026 | Published: 14 September 2026
Keywords: cardiomyopathy; cardiac amyloidosis; myocardial
Cardiac amyloidosis usually transpires when systemic amyloid gets deposited within the myocardial tissues, thus sparking the onset of restrictive cardiomyopathy. In this regard, there are two forms of cardiac amyloidosis namely amyloid light chain (ALC) amyloidosis caused by accumulation of immunoglobulin light chains and transthyretin amyloidosis instigated by deposition of transthyretin (ATTR) amyloid
Cardiac amyloidosis usually transpires when systemic amyloid gets deposited within the myocardial tissues, thus sparking the onset of restrictive cardiomyopathy. In this regard, there are two forms of cardiac amyloidosis namely amyloid light chain (ALC) amyloidosis caused by accumulation of immunoglobulin light chains and transthyretin amyloidosis instigated by deposition of transthyretin (ATTR) amyloid [1]. In this short communication, we will mainly focus on treatment options for ATTR cardiac amyloidosis, which our current clinical case highlights and we will also provide future research areas that needs out attention to
The patient is a 51 y/o female with a complex PMHX including COPD, HFpEF (11/25 EF 65%), restrictive cardiomyopathy with ICD placement, CAD with prior NSTEMI, hypertension, type 2 diabetes, hypothyroidism, GERD with esophageal ulcer, chronic constipation/IBS, anxiety and depression, OSA on CPAP, chronic sinusitis, and neuropathy. She was recently hospitalized from 9/3–9/14/25 for acute hypoxic respiratory failure due to a COPD/HFpEF exacerbation. She presented again with recurrent shortness of breath and central chest pressure described as “someone stepping on my chest/ I feel like i'm drowning,” accompanied by nausea, orthopnea, and near-syncope. EMS found her oxygen saturation at 83% on room air, improving rapidly with supplemental oxygen. On admission, she remained dyspneic but hemodynamically stable. Her initial workup showed a mildly elevated troponin level with no significant delta change, a BNP of 519, and chest radiography showing cardiomegaly without infiltrates or pulmonary congestion. She was diagnosed with acute hypoxemic respiratory failure secondary to a COPD exacerbation. She was treated with supplemental oxygen, DuoNebs, systemic steroids (later transitioned to IV Solu-Medrol), and a 5-day course of doxycycline. Her respiratory status improved steadily, and she stabilized on room air. Infectious evaluations, including a respiratory viral panel and strep test, were negative. Her initial chest pain was attributed to type II myocardial injury from hypoxemia. She remained on aspirin, clopidogrel, and high-intensity statin therapy, and her metoprolol dose was decreased from 50mg BID to 25mg BID due to persistent hypotension. Serial troponin levels remained stable. Cardiology was consulted and given her history of hypertrophic cardiomyopathy with HFpEF and persistent symptoms, she underwent an extensive cardiac evaluation. An echocardiogram 11/20 showed concentric LV hypertrophy with left atrial dilation. A nuclear medicine amyloidosis scan 11/24 returned positive for Grade 3 cardiac ATTR amyloidosis. A left heart catheterization on 11/25 revealed minimal coronary artery disease (40–50% diagonal branch stenosis), normal LVEF at 65%, and an elevated LVEDP, supporting restrictive physiology. Cardiology recommended initiation of disease-specific therapy with Vutrisiran (Amvuttra) as an outpatient; arrangements are in progress given that this medication is not available inpatient. Management of her HFpEF was adjusted throughout hospitalization. She had no clear signs of volume overload on exam, and a bedside IVC assessment at one point showed collapsibility; she received a cautious fluid bolus. Torsemide was held initially and then diuresis was resumed per cardiology once elevated LVEDP was confirmed. She was monitored on telemetry due to frequent PVCs and brief non-sustained ventricular tachycardia; patient has been instructed to take her Metoprolol Succinate 50mg every night right before bed so that it helps with her v-tach overnight. Her chronic conditions were managed throughout admission. Her diabetes remained controlled on Jardiance with sliding-scale insulin while metformin was held. Her hypothyroidism continued to be treated with levothyroxine. GERD symptoms improved with pantoprazole and a GI cocktail. She continued her psychiatric medications and bowel regimen without complication. By discharge, the patient was breathing comfortably on room air, denied recurrent chest pain, and was hemodynamically stable. Her metoprolol dose will remain at 50mg every night before bed. The primary and cardiology teams agreed that she is stable for discharge with close outpatient follow-up, particularly for initiation of Vutrisiran therapy for ATTR cardiac amyloidosis. She is instructed to continue her home medications as adjusted during hospitalization, adhere to strict daily weights and monitoring of symptoms, use her CPAP nightly, and follow up with cardiology promptly for ongoing management of her newly diagnosed Amyloidosis, restrictive cardiomyopathy, HFpEF, and ICD monitoring. She should also seek medical care urgently if she develops recurrent chest pain, increasing dyspnea, dizziness, edema, or syncope.
Both ALC and ATTR forms of cardiac amyloidosis come to light with restrictive cardiomyopathy, with preserved ejection fraction heart failure, hepatomegaly, peripheral neuropathy and nephrotic syndrome [2]. ATTR cardiac amyloidosis is further classified into two types namely wild type with predominant cardiac involvement whereas variant type with prevalent sensorimotor peripheral neuropathy [2]. Our patient primarily had ATTR cardiac amyloidosis which has incidence and prevalence of 0.3 cases per year per 100,000 and 155-191 per million person respectively [2]. Over and beyond the Guideline Directed Medical therapy (GDMT) for heart failure that is indispensable, American College of Cardiology (ACC) recommends few disease specific therapies that are targeted towards functional dynamics or genetic expression of TTR, which are efficacious in slowing the progression of disease, cardiovascular morbidity/mortality and improving the quality of life in these patients [1]. In the next set of sections, we briefly dive in these therapeutic modalities to enumerate their mechanism of action, therapeutic efficacy. toxic side effects and their clinical efficacy in managing ATTR amyloidosis.
Transthyretin stabilizers
Tafamidis is a protype of transthyretin stabilizers and it approved by FDA by fast-track pathway for treatment of wild type or variant cardiac amyloidosis in 2019 [1, 3]. With regard to its mechanism of action, it is speculated that misfolding of ATTR leads to decreased solubility, increased crystallization, heightened incorporation into amyloid fibrils [1, 3, 4]. These turn of events provides the impetus for driving the enhanced accumulation of systemic amyloid in the myocardial tissues [1, 3]. TTR stabilizers mainly act through stabilization of TTR structure, thereby reducing amyloid formation, and subsequently limiting its propensity for migration and building up of amyloid in the myocardial tissues [1, 3]. Tafamidis is prototype TTR stabilizer that is mainly used in of cardiomyopathy and peripheral neuropathy associated with amyloidosis [3, 4]. It is absorbed within 4h, undergoes hepatic glucuronidation metabolism and excrete through kidney with a half-life of 49h [3]. It is currently available in 2 forms namely Tamadifis free form 61 mg and Tanadifis meglumine 20 mg [3]. Its primary adverse effects include headache, urinary tract infection, peripheral edema, diarrhea, pneumonia, acute heart failure, punctate keratitis and vaginitis [3]. It is contraindicated in pregnancy, NYHA Class IV heart failure and severe renal dysfunction [3]. Close attention should be paid when Tamadifis is administered with Rosuvastatin (risk of rhabdomyolysis), methotrexate, imatinib and rimegepant[3]. In Tamadifis in Transthyretin Cardiomyopathy Clinical Trial, where 441 patients were randomized to Tamadifis or placebo and followed for 30 months, patients in Tamadifis treatment arm demonstrated decreased cardiovascular hospitalizations, lowered all-case mortality and improved functional quality of life as compared to patients in control arm [5].
Transthyretin silencers
Primary prototypes include Vutrisiran and Patisiran. These class of drugs are primarily classified as small interfering RNAs (SiRNAs). These drugs have as innate dominant affinity to bind and destroy TTR target mRNA in the hepatocytes, thus reducing the production of mutant and wild type TTR [6]. It is absorbed within 3-5h, and has a half-life of 4.3-7.5h [7]. It showed a proportional increase in plasma concentrations in a dose-dependent manner, thus translating into 55-97% reduction in TTR liver synthesis after continuous 90-day administration [7]. In multiple clinical trials including Helios B trial, patients randomized to Vutrisiran has experienced decreased cardiovascular event related hospitalizations, lowered risk of death, lessened amyloid burden, superior cardiac structure & function, attenuated risk of amyloid cardiomyopathy and improved quality of life [8-10].
CRISPR/Cas9 gene editing agents
First class of gene therapies that are currently in investigation include CRISPR/Cas9 [Clustered Regularly Interspaced Short Palindromic Repeats. Caspase-9] gene editing drugs including nexiguran and ziclumeran (nex-z) [1]. These agents cleave and re-ligate the TTR DNA strand with insertion and deletion errors [6]. This will eventually decrease functional mRNA production and subsequent TTR protein production in the liver [6]. Currently, a phase -3 clinical trial of these agents with ATTR cardiomyopathy is currently is ongoing which is estimated to be completed by 2028 [1].
Amyloid fibril annihilators with monoclonal antibodies
In histopathological analysis of patients with ATTR cardiac amyloidosis, few patients were noted to have anti-amyloid immune response with accumulation of anti-transthyretin IgG and complement 3 around deposits [11]. As these antibodies bind specifically to amyloid deposits, further research and harnessing their potential to demolish the amyloid deposits will be wirth investigating further [11]. If the efforts to develop and fortify the monoclonal antibodies which will specifically target the myocardial amyloid deposits becomes viable therapeutic option, then it opens a door for decimating these amyloid deposits in the myocardium. Specifically, it provides an avenue for destroying and downscaling these amyloid deposits through immune clearance pathways by activating macrophages, complement, cytokines and chemokines. This would be beneficial to with respect to recuperating myocardial pump function, chamber compliance, clinical function, functional recovery, symptom profile, organ involvement and clinical outcomes, thus promoting reverse remodeling of ATTR cardiac amyloidosis. Currently, there are two clinical trials that are investing the role of these agents that can potentially target and destroy cardiac amyloid [12, 13].
Currently, patients with cardiac amyloidosis can be offered few therapeutic options including transthyretin stabilizers and silencers. These agents slow disease progression, improve cardiac function, decrease hospitalization rate, reduce risk of death and promote the functional quality of life. Current studies reveal that there seems to be no superiority of one agent over other or need for combination therapy. Newer therapies that are currently in investigation include CRISPER-CAS9 gene editing agents and monoclonal antibodies. These agents might potentially change the therapeutic paradigm of ATTR cardiac amyloidosis with their different mechanism of action, clinical efficacy, safety profile, and ease of administration. Multiple clinical trails of ATTR cardiac amyloidosis are still in process and results of these might offer new therapeutic options and drastically change the therapeutic landscape of this infiltrative cardiomyopathy.
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Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
