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Hemodynamic testing to guide vasodilator therapy in cardiac amyloidosis. | LitMetric

AI Article Synopsis

  • Cardiac amyloidosis is typically treated with diuretics, but vasodilators are often avoided due to hypotension risks; however, their use may be reconsidered in decompensated heart failure cases.
  • A case study highlighted a patient with advanced cardiac amyloidosis showing improvement after receiving nitroprusside, which increased cardiac output and alleviated symptoms.
  • This suggests that certain patients with cardiac amyloidosis in decompensated heart failure can benefit from hemodynamic testing and afterload-reducing medications, offering new treatment possibilities where diuretics alone are insufficient.

Article Abstract

Unlabelled: Cardiac amyloidosis is a restrictive cardiomyopathy for which diuretics are frequently used, but vasodilators have classically been relatively contraindicated due to side effects of hypotension. In the setting of decompensated heart failure, this may not be the case. We report a man with advanced cardiac amyloidosis who presented to the hospital with decompensated heart failure, in part, due to elevated systemic vascular resistance. Through the use of invasive hemodynamic testing, we were able to demonstrate an increase in cardiac output in response to a nitroprusside challenge. In turn, the patient had an improvement in his symptoms and was sent home on afterload reducing medications. This discerns a subpopulation of cardiac amyloidosis patients in decompensated heart failure who benefit from medications that reduce systemic vascular resistance, and can benefit from hemodynamic testing, especially when diuretics fail to control symptoms.

Learning Objective: Medications that cause peripheral vasodilation are standard therapy for patients with reduced ejection fraction, however, they are seldom used for patients with cardiac amyloidosis due to adverse effects. In some cases, there may be value in using hemodynamic measurements in patients with advanced cardiac amyloidosis to guide management as some patients may have hemodynamics that resemble those of systolic heart failure. This may offer a novel approach to symptomatic treatment of advanced cardiac amyloidosis.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10477047PMC
http://dx.doi.org/10.1016/j.jccase.2023.04.011DOI Listing

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