Ridefinizione della Terapia Medica Ottimale per la Frustrazione Cardiaca in Cardiomiopatia da Transtiretina Amyloidica.

Amyloid transthyretin cardiomyopathy (ATTR-CM) is an infiltrative cardiomyopathy and an underdiagnosed cause of heart failure (HF) across the left ventricular ejection fraction spectrum. As disease-modifying therapies prolong survival, outcomes are increasingly shaped by non-amyloid-specific HF care. Restrictive physiology and frequent autonomic dysfunction create a narrow therapeutic window in which small changes in preload or afterload may precipitate hypotension, renal injury, and low-output symptoms. Loop diuretics remain foundational, requiring individualized dosing, preference for agents with predictable bioavailability when absorption is uncertain, and early, closely monitored combina