{
  "abstract": "Background: Transthyretin cardiac amyloidosis (ATTR-CM) is a progressive infiltrative cardiomyopathy where early disease-modifying therapy improves outcomes. However, treatment access may be restricted by biomarker thresholds not reflecting true functional impairment. Case Summary: A 73-year-old man with exertional dyspnea (NYHA functional class II) and confirmed wild-type ATTR-CM did not meet reimbursement criteria for tafamidis because N-terminal pro–B-type natriuretic peptide was below the required threshold (≥600 pg/mL), despite impaired functional capacity on cardiopulmonary exercise testing (CPET). Acoramidis was obtained through expanded access. At 6-month follow-up, the patient showed clinical stability and improved exercise capacity. Discussion: Fixed N-terminal pro–B-type natriuretic peptide cutoffs may exclude patients with early-stage heart failure who would benefit from treatment. CPET helps identify therapy candidates below biomarker thresholds. Take-Home Messages: CPET detects functional impairment in ATTR-CM even when natriuretic peptides remain low. Early transthyretin-stabilizer initiation in NYHA functional class I-II yields better outcomes; treatment eligibility should integrate functional assessment beyond biomarkers alone.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Rio Hortega University Hospital, Valladolid, Spain"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sara Rioja-Abad, MD"
    },
    {
      "affs": [
        0
      ],
      "name": "Ramon Andion-Ogando, MD"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria Perez-Diaz, MD"
    },
    {
      "affs": [
        0
      ],
      "name": "Cristina Barinaga-Martin, MD"
    },
    {
      "affs": [
        0
      ],
      "name": "Jordi Candela-Ferre, MD"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria Jesus Rollan-Gomez, MD, PhD"
    },
    {
      "affs": [
        0
      ],
      "name": "Ignacio Hernandez-Gonzalez, MD, PhD"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria del Mar de la Torre-Carpente, MD, PhD"
    },
    {
      "affs": [
        0
      ],
      "name": "Hector Garcia-Pardo, MD"
    },
    {
      "affs": [
        0
      ],
      "name": "Juan Carlos Muñoz-San Jose, MD, PhD"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/14fj43rgwfywn.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jaccas.2026.110006",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2666084926031670",
  "id": "14fj43rgwfywn",
  "issns": [
    "2666-0849"
  ],
  "landing_url": "https://doi.org/10.1016/j.jaccas.2026.110006",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Cardiac Amyloidosis"
    ],
    [
      "heading",
      "Clinical Case"
    ],
    [
      "lcc",
      "RC666-701"
    ],
    [
      "openalex",
      "1312|Amyloidosis: Diagnosis, Treatment, Outcomes"
    ]
  ],
  "openalex": "W7204229119",
  "pdf_url": "https://www.jacc.org/doi/pdf/10.1016/j.jaccas.2026.110006?download=true",
  "pmcid": "PMC13698931",
  "pmid": "42644794",
  "published": "2026-08-26",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/14fj43rgwfywn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:26Z",
      "native_id": "189d007282af44c29650ca48626f4c56",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.jaccas.2026.110006"
    },
    {
      "first_seen": "2026-10-30T12:19:38Z",
      "native_id": "PMC13698931",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jaccas.2026.110006"
    }
  ],
  "subjects": [
    {
      "field": "biochemistry",
      "origin": "openalex:1312|Amyloidosis: Diagnosis, Treatment, Outcomes",
      "subfield": "molecular-biology"
    }
  ],
  "title": "Cardiopulmonary Exercise Testing Identifies Treatable ATTR Cardiac Amyloidosis",
  "title_text": "Cardiopulmonary Exercise Testing Identifies Treatable ATTR Cardiac Amyloidosis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:15Z",
  "url": "https://research.draconitic.com/paper/14fj43rgwfywn",
  "venue": "JACC: Case Reports",
  "versions": []
}