Insights into the renin-angiotensin-aldosterone system in transthyretin amyloid cardiomyopathy

ATTR-CM patients exhibit distinct RAAS profiles, with increased ACE2 activity and a shift toward the alternative RAAS axis in more advanced disease. Higher ACE2 activity is associated with higher NT-proBNP, biventricular dysfunction and adverse cardiac outcomes, suggesting that ACE2 may represent a promising marker for risk stratification in ATTR-CM.