Effect of Angiotensin Receptor/Neprilysin Inhibitors on Transthyretin Cardiac Amyloidosis and Heart Failure with Reduced Ejection Fraction

Prior treatment

• Treatment with ACE inhibitors, ARBs, or sacubitril/valsartan at the time of enrollment.
• Treatment with TTR gene silencers or diflunisal.

Other illness

• History of angioedema or hypersensitivity to ACE inhibitors or ARBs.
• Any condition that, in the investigator's opinion, compromises participation in the study.

Lab values

• Stage 4 and 5 chronic kidney disease (creatinine clearance by CKD-EPI \<30 mL/min/1.73m²).
• Hyperkalemia (blood potassium levels \> 5.4 mmol/L).

Other

• NYHA Functional Class IV.
• Hypotension defined as systolic blood pressure (SBP) \<100 mmHg on two consecutive measurements.
• Participation in another clinical trial.
• Pregnancy, breastfeeding, or fertile women unwilling to use adequate contraception throughout the study duration.

• Patients ≥ 18 years of age of both sexes.
• Patients diagnosed with ATTR cardiac amyloidosis as indicated in guidelines, both in its hereditary form (ATTRv) or wild-type form (ATTRwt).
• Patients initially evaluated or under follow-up in Cardiomyopathy/Heart Failure/Amyloidosis Units at participating centers.
• Heart failure and reduced ejection fraction: LVEF ≤40%, in functional class I, II, or III according to the New York Heart Association (NYHA).