Tafamidis in patients with amyloid cardiomyopathy: a systematic review and meta-analysis of 14 studies

Abstract

Abstract Introduction Amyloid cardiomyopathy is a form of restrictive cardiomyopathy where beta blockers and ACE inhibitors were used for symptomatic relief without reversal of the underlying disease. Studies reported that tafamidis delays structural and functional changes in the heart with conflicting results. Aim We aimed to give a comprehensive analysis of the effect of tafamidis on cardiovascular outcomes. Methods PubMed, Scopus, WOS, and Cochrane were retrieved from inception until May 2024 for relevant studies that assessed the effect of tafamidis compared to standard of care in patients with amyloid cardiomyopathy. Clinical parameters of the heart, such as ejection fraction, interventricular septum thickness, and percentage of global longitudinal strain, were studied, as well as cardiovascular outcomes such as all-cause mortality and hospitalization from cardiovascular causes. Results 14 studies were included in this meta-analysis with a total of 3615 patients., tafamidis showed a significant reduction in all-cause mortality and heart transplantation compared to standard care (RR 0.60, 95%CI [0.54 to 0.68]) and hospitalization rates (RR 0.80, 95%CI [0.70 to 0.90]). Regarding functional and structural heart outcomes, tafamidis showed an increase in left ventricle ejection fraction (MD, 1.32, 95% CI [-1.13 to 3.77]), It also showed a decrease in interventricular septum thickness (MD, -0.88, 95%CI [-1.86 to 0.10]). Conclusion Tafamidis was associated with favorable outcomes regarding all cause mortality, heart transplantation and hospitalization, it also showed delay in structural changes compared to standard of care but Large-volume RCTs are warranted to validate the current findings.All cause mortality and HT Hospitalization