2a) This program is intended for #HCPs and is supported by an independent grant from BridgeBio. You can earn a full 1 hr of 🆓CE/#CME credit by following this 🧵!#cardioX #cardioTwitter #MedEd #ATTRCM #ATTRCMAwareness #KnowATTRCM #ATTRAmyloidosis #CardiacAmyloidosis
— cardio-met (@cardiomet_CE) March 17, 2026
3a) #ATTR #amyloidosis is a progressive and life-threatening disease caused by misfolded #transthyretin #TTR protein deposition. Do we have updated epidemiology data for ATTR amyloidosis?
— cardio-met (@cardiomet_CE) March 17, 2026
(Figure from 🔓 https://t.co/f0OeZRlWHW ) pic.twitter.com/cTPZyIwRVA
4a) Do you know which phenotype drives most incident cases of amyloidosis in the US?
— cardio-met (@cardiomet_CE) March 17, 2026
5) So, is #ATTR incidence increasing?
— cardio-met (@cardiomet_CE) March 17, 2026
Yes. From 2019–2022:
• Overall ATTR incidence ↑ 6.9–9.2%
• ATTR-CM incidence ↑ ~10%
• ATTR-CM-only ↑ up to 13.9%
📈 Growth largely driven by cardiac phenotype.
See 🔓 https://t.co/RtN4xVM6Zr
6b) In an observational study of #ATTR phenotypes (🔓 https://t.co/RtN4xVM6Zr), investigators compared comorbidity burden across pts with #ATTR_CM, #ATTR_PN (polyneuropathy), & mixed ATTR phenotypes.
— cardio-met (@cardiomet_CE) March 17, 2026
Which phenotype is generally associated with the highest comorbidity burden?
7a) 2019–2022: incidence of overall #ATTR ⬆️~7–9%, clearly driven by #ATTR-CM (~10% ⬆️). This study ➡️22–26% ⬆️ overall ATTR prevalence over just 3y. #ATTRCM accounts for most of the ⬆️. Trends were consistent across narrow vs broad defs, tho absolute numbers differed alot.
— cardio-met (@cardiomet_CE) March 17, 2026
7c) ⤴️ #ATTRCM prev is multifactorial:
— cardio-met (@cardiomet_CE) March 17, 2026
• Improved diagnostic pathways (bone scintigraphy adoption)
• ⬆️ disease awareness
• Survival ⬆️ from disease-modifying therapy #DMT
Epidemiologic shift parallels DMT era after #ATTR_ACT, which ➡️⬇️ mortality & CV hosp w/#tafamidis.
9a) More new data: #VHA retrospective cohort study 🔬2,557 pts w/#HF + #ATTR_CM dx'd 2016–2022. https://t.co/gJd5ypQrzU. Median time to ATTR-CM dx was 490 days, and for those on loop diuretics before diagnosis, the median delay was 835 days (Q1–Q3: 250–1850). pic.twitter.com/3hjQ6XjYyG
— cardio-met (@cardiomet_CE) March 17, 2026
9c) Delayed dx of ATTR-CM is common in veterans: >25% wait >3yr! Among 1,185 w/ prior #HF hosp, median delay = 300d (Q1–Q3: 59–862). Median delay: Black veterans 447d (61–1,199), White veterans 552d (77–1,373).
— cardio-met (@cardiomet_CE) March 17, 2026
9e) Why does delayed ATTR-CM dx persist despite approved #DMTs #tafamidis #acoramidis #vutrisiran?
— cardio-met (@cardiomet_CE) March 17, 2026
In this #VHA cohort >25% waited >3yr. AF, CAD, and CKD ⬆️ odds of delay ➡️anchoring bias may mask amyloidosis as “garden variety” #HFpEF.
10) What else is new in 2026?#ATTRCM is often underdiagnosed until significant 🫀damage occurs. A new UK study explored routine carpal tunnel biopsy to detect amyloid early.
— cardio-met (@cardiomet_CE) March 17, 2026
Do you think carpal tunnel biopsy could enable earlier diagnosis of ATTR-CM?
11b) Of 216 biopsy-pos pts, 116 agreed to 🫀 assessment with bone #scintigraphy. Amyloid found in . 32 (28%). 10 had Perugini grade 2 uptake; rest grade 1. Echo + serum biomarkers ➡️signif #ATTRCM in pts with Perugini grade 2 DPD scans, prompting commencement of DMT. pic.twitter.com/SW7b4loG4A
— cardio-met (@cardiomet_CE) March 17, 2026
12b) See 🔓https://t.co/Fep2c968lD. 👀sex-specific diffs in dx, imaging, & outcomes re earlier detection in ♀️among pts w/confirmed #ATTRCM at the West German Amyloidosis Center (2018–2024), excluding AL amyloidosis.
— cardio-met (@cardiomet_CE) March 17, 2026
12d) #Echo in #ATTRCM ➡️sex diffs:
— cardio-met (@cardiomet_CE) March 17, 2026
· LVEF: ♀️⬆️ (55% v 53%, P < 0.001)
· IVSD: ♀️ ⬇️ (16.2 v 18.1 mm, P = 0.026)
· Stroke vol: ♀️⬇️ (49 v 56 mL, P = 0.020)
· LV mass index: similar pic.twitter.com/QhZPSVX0Io
12f)
— cardio-met (@cardiomet_CE) March 17, 2026
🫀IVSD: Women had smaller septal thickness (6 mo: 15.2 vs 19.1 mm, P < 0.001; 12 mo: 16.1 vs 19.0 mm, P = 0.003)
This study ➡️ women show milder structural remodeling over time ✅
🔓https://t.co/Fep2c968lD#SexDisparities #WomenInCardiology
13a) Now we know that #ATTRCM is progressive & early tx matters. So, how do we manage ATTR-CM in 2026?
— cardio-met (@cardiomet_CE) March 17, 2026
With DMT now central: TTR #stabilizers (#tafamidis, #acoramidis) & gene #silencers (#vutrisiran), alongside optimized HF care are promising to tackle this .
14b) 72♂️ w/wild-type #ATTRCM & #NYHA class II #HF starts #acoramidis therapy. He is closely monitored for clin outcomes, inc all-cause mortality & 1st CV hosp.
— cardio-met (@cardiomet_CE) March 17, 2026
Per clinical trial evidence, after how long did acoramidis 1st show a significant ⬇️in #ACM or 1st CV hospitalization?
14d) Looking deeper into #ATTRibute_CM: the 4-step hierarchical primary endpoint (#ACM, #CVH, #NTproBNP, #6MWD) favored #acoramidis at 30mos (win ratio 1.8; p<0.0001).
— cardio-met (@cardiomet_CE) March 17, 2026
RRR: ACM ↓23% (HR 0.77), CVH ↓50% (p<0.0001; NNT=5/yr). pic.twitter.com/74QzxYcymy
14f) From same analysis, new data on #QoL improvement with #acoramidis in #ATTRCM:
— cardio-met (@cardiomet_CE) March 17, 2026
At 30 mos, patients had +10 points in #KCCQ_OS vs placebo. EQ_5D_5L showed a 0.13 LS mean difference (95% CI 0.07–0.18; p<0.0001), and the visual analog scale improved by 10 points (p<0.0001).
15a) #ATTRCM carries a poor prognosis, with mortality ~3–4 yrs if untreated. Data from #ATTRibute_CM show #acoramidis provides robust, sustained clinical benefit across endpoints (ACM/CVH) through 30–42 months, with early effects seen by 3 months.
— cardio-met (@cardiomet_CE) March 17, 2026
15c) . . . testing prophylactic #acoramidis in asymptomatic pathogenic TTR variant carriers, aiming to delay or prevent onset of #cardiomyopathy or #polyneuropathy over 5 years.
— cardio-met (@cardiomet_CE) March 17, 2026
16b) Data from ATTRibute-CM & its open-label extension show that consistent benefit:
— cardio-met (@cardiomet_CE) March 17, 2026
· Primary 4-component endpoint win ratio: 1.8 (#ATTRwt), 2.5 (#ATTRv)
· ACM/first CVH HR: 0.69 (#ATTRwt, 31% risk ⬇️), 0.41 (#ATTRv, 59%)
· Annual CVH frequency ⬇️49% (#ATTRwt), ⬇️62% (#ATTRv) pic.twitter.com/2ALKvsaVAW
16d) Finally, in 🔓 https://t.co/cjhIBwkxK5, we see favorable impacts on biomarkers, function, & QoL in both wild-type (#ATTRwt) and variant (#ATTRv) populations. These data highlight robust, early, & sustained functional & pt-centered benefit with #acoramidis across genotypes. pic.twitter.com/P3EgPRZzLN
— cardio-met (@cardiomet_CE) March 17, 2026
17b) Data from 🔓 https://t.co/cjhIBwkxK5 confirm that #acoramidis provides meaningful, sustained benefits in both #ATTRwt & #ATTRv-CM:
— cardio-met (@cardiomet_CE) March 17, 2026
· Early ↑ in sTTR & stabilization of NT-proBNP
· Preservation of 6MWD & functional capacity
· Significant ⤴️in quality of life (KCCQ-OS)
18a) One last notable pub. Amyloid deposits in the #myocardium ➡️progressive biventricular #HF, recurrent #CVH, & death within 3–10y if untreated. In a pt w/#ATTRCM, which change at 1y would make you most concerned about increased mortality risk?
— cardio-met (@cardiomet_CE) March 17, 2026
18c) We found out in 🔓https://t.co/R7E2sHPKJ1 by Cappelli et al, another new analysis from #ATTRibute_CM pic.twitter.com/b99jZTgJtD
— cardio-met (@cardiomet_CE) March 17, 2026
18e) A shift from event reduction → holistic disease control? This post-hoc analysis from #ATTRibute-CM eval'd response categories based on change baseline ➡️ 30 mos in #NTproBNP concentration & #6MWD-a composite, pt-centered assessment aligned w/real-world disease progression. pic.twitter.com/EBKuvU7ZKk
— cardio-met (@cardiomet_CE) March 17, 2026
18g) A significantly higher proportion of pts in the #acoramidis group reached clinically meaningful improvement #CMI in NT-proBNP or 6MWD (22.7%) compared with the placebo group (8.9%; OR 3.0, 95% CI 1.8–5.1; P < .001).
— cardio-met (@cardiomet_CE) March 17, 2026
19a) So what have we learned?#ATTRCM is a progressive infiltrative cardiomyopathy often diagnosed late ~1 year from symptom onset to therapy. Women are underrepresented, and current thresholds (e.g., IVSD ≥12 mm) may miss female phenotypes.
— cardio-met (@cardiomet_CE) March 17, 2026
20) We will continue to update the evidence basis on improving recognition of #ATTRCM and evaluating response to #TTR #stabilizer therapy throughout 2026. FOLLOW US so you don’t miss anything! pic.twitter.com/MQ7foSWWFv
— cardio-met (@cardiomet_CE) March 17, 2026
21) And for now, point your 🖱️to https://t.co/v79ze5ixrn and claim your 🆓ONE HOUR CE/#CME! Many thanks to our expert author, @HanCardiomd!#MedEd
— cardio-met (@cardiomet_CE) March 17, 2026