Natriuretic Peptide and Transthyretin and Their Relationship With Clinical Outcomes: Results From ATTRIBUTE-CM, a Randomized Controlled Trial.

In 30 seconds

This post hoc biomarker analysis of ATTRIBUTE-CM, a phase 3 randomized, double-blind, placebo-controlled trial, examined baseline NT-proBNP and serum transthyretin (sTTR) in 632 participants with transthyretin amyloid cardiomyopathy. Higher NT-proBNP and lower sTTR were associated with greater disease severity and each independently predicted all-cause mortality or first cardiovascular hospitalization, and cardiovascular mortality or first cardiovascular hospitalization, through Month 30. Their combination was additively prognostic: higher NT-proBNP with lower sTTR corresponded to higher risk and shorter time to events. Acoramidis showed consistent efficacy across baseline biomarker groups.

Key findings

• Higher baseline NT-proBNP and lower sTTR were associated with greater disease severity and were inversely correlated.
• Each biomarker was independently associated with all-cause mortality or first cardiovascular hospitalization and cardiovascular mortality or first cardiovascular hospitalization.
• Higher NT-proBNP combined with lower sTTR was associated with higher risk and shorter time to event.
• Acoramidis reduced risk of both composite outcomes regardless of baseline NT-proBNP/sTTR status, disease stage, or nutritional risk.

Why it matters

The findings suggest that NT-proBNP and sTTR provide complementary prognostic information in transthyretin amyloid cardiomyopathy. Considering both biomarkers may help characterize disease severity and refine risk assessment beyond either marker alone, while the reported consistency of acoramidis efficacy across biomarker groups indicates that baseline levels did not identify a subgroup without observed benefit in this trial.

What to keep in mind

The biomarker analysis was post hoc, and the abstract does not report quantitative effect estimates for the prognostic associations.