Myocardial Responses to Eplontersen in Transthyretin Amyloid Cardiomyopathy: The CARDIO-TTRansform CMR study.

Eplontersen lowered myocardial extracellular volume by -6.7 percentage points versus placebo at week 140 in transthyretin amyloid cardiomyopathy patients.

• Why it matters: Transthyretin-lowering therapies aim to reduce ATTR-CM burden, but how myocardial amyloid and cardiac remodeling change over time is not fully defined.
• What they did: In an international prospective CMR substudy of the randomized, placebo-controlled phase 3 CARDIO-TTRansform trial, participants had serial multiparametric CMR at baseline and weeks 25, 49, 97, and 140. Mixed models assessed longitudinal CMR parameters, with amyloid regression/progression defined by ≥5 percentage-point decreases/increases in ECV.
• The result: At week 140, eplontersen also reduced native T1 (-25.9 ms) and left ventricular mass (-19.1 g), improved biventricular ejection fractions, and increased strain measures versus placebo. Myocardial amyloid regression occurred in 12.5% with eplontersen versus 0% with placebo, while progression occurred in 12.5% versus 76%, respectively.

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