{"id":"a8779844de09","type":"article","url":"https://hartvaat.nl/2026/09/26/acei-arb-arni-verlagen-mortaliteit-bij-al-cardiale-amyloidose/","title":"ACEi/ARB/ARNi verlagen mortaliteit bij AL-cardiale amyloïdose","title_en":"Efficacy and Safety of ACEi, ARB, and ARNi in Cardiac Amyloidosis: A Retrospective Propensity Score-Matched Cohort Study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Current problems in cardiology","doi":"10.1016/j.cpcardiol.2026.103458","source_url":"https://doi.org/10.1016/j.cpcardiol.2026.103458","authors":["Hassan Kawtharany","Nadine Mahmoud","Abdallah Rayyan","Mohammad Ghazal","Noel Dasgupta","Nitasha Sarswat","Vaishali Sanchorawala","Faizi Jamal"],"significance":5,"published":"2026-10-05","source_date":"2026-09-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/mra-bij-hartfalen/"],"congress":"","summary_en":"A retrospective propensity-matched cohort study of 5,134 patients with cardiac amyloidosis found that ACEi/ARB/ARNi therapy was associated with lower all-cause mortality (HR 0.64) but higher rates of hospitalization and adverse events such as AKI and hyperkalemia. The survival benefit was confined to AL amyloidosis (HR 0.57) and was not observed in ATTR amyloidosis. These real-world findings suggest a potential role for RAAS inhibition in selected AL patients, though randomized trials are needed to establish definitive efficacy and safety.","created":"2026-09-28T01:17:28Z","updated":"2026-09-28T01:17:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een retrospectieve propensity-gematchte cohortstudie onder 5.134 patiënten met cardiale amyloïdose toont aan dat behandeling met ACEi, ARB of ARNi gepaard gaat met een lagere sterfte (HR 0,64), maar ook met meer ziekenhuisopnames en bijwerkingen zoals nierfalen en hyperkaliëmie. Het overlevingsvoordeel blijft zichtbaar bij patiënten met AL-amyloïdose (HR 0,57), maar niet bij ATTR-amyloïdose. Deze real-world data ondersteunen het gebruik van RAAS-remming bij geselecteerde AL-patiënten, maar benadrukken de noodzaak van gerandomiseerde trials om de veiligheid en effectiviteit definitief te bevestigen.","abstract_original":"INTRODUCTION: Angiotensin-converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB), and angiotensin receptor-neprilysin inhibitor (ARNi) improve outcomes in non-amyloid heart failure populations; however, their role in cardiac amyloidosis (CA) remains uncertain. METHODS: We conducted a retrospective cohort study using the TriNetX Research Network including patients with CA. Patients receiving ACEi/ARB/ARNi were compared with those not receiving these therapies. Propensity score matching (1:1) was performed. Outcomes included all-cause mortality, hypotension, acute kidney injury (AKI), hyperkalemia, dizziness, and hospitalization over 3 years. Subgroup analyses were performed by sex, left ventricular ejection fraction (LVEF ≤40% vs >40%), and amyloidosis subtype. RESULTS: Among 5,134 patients, 1,692 (33.0%) received ACEi/ARB/ARNi. After matching, 1,447 patients remained in each group. Treatment was associated with lower all-cause mortality (HR, 0.64; p<0.001) but higher hospitalization (HR, 1.32; p<0.001). Risks of hypotension were similar, whereas AKI, hyperkalemia, and dizziness were higher with treatment. Findings were consistent across sex. Mortality reduction persisted in patients with LVEF >40% (HR 0.63, p < 0.001) and showed a similar non-significant trend in those with LVEF ≤40% (HR 0.58, p=0.058). A survival benefit was observed in AL amyloidosis (HR, 0.57; p <0.001) but not in ATTR amyloidosis (HR, 0.78; p=0.122). CONCLUSIONS: In selected patients with AL CA, treatment with ACEi/ARB/ARNi is associated with lower mortality; this association was not observed in patients with ATTR amyloidosis. Therapy was associated with a higher risk of side effects and hospitalizations. Randomized trials are needed to clarify the role of RAAS inhibition in CA."}