| | December 20219UTLOOKHealthcare Tech adjusting heart failure therapy and offering palliative care. Cardiac imaging for TTR cardiac amyloidosis was limited to academic medical centers and genetic testing, while available, was rarely performed for family screening.In the summer of 2018, the results of phase 3 clinical trials for patisiran and inotersen were published simultaneously in the NEJM demonstrating the use of silencing RNAi and antisense oligonucleotide therapeutics to inhibit hepatic expression of mutant TTR. These two drugs were the first approved targeted therapies to silence mutant gene expression and the first wide application of targeted therapy in cardiomyopathy.Now the outcome of a genetic test has a direct impact on therapeutic choice in TTR amyloidosis. The collapse of this barrier is a dramatic increase in the utilization of genetic testing for cardiac amyloidosis. In our system patients referred for genetic evaluation of amyloidosis rose to 30% of all patients referred for cardiac genetic testing.Precision medicine for cardiomyopathy is not limited to amyloidosis. Multiple targeted therapeutics for cardiovascular disease are currently being developed or are in clinical trials. One of the more promising therapeutics on the horizon is ARRY-797. Currently in phase 3 clinical trials, this drug inhibits the downstream over activation of the p38 mitogen activated protein kinase (MAPK) that occurs in the presence of a non-functional lamin A (LMNA) protein. The unchecked activation of the p38 MAPK pathway causes downstream changes in the cardiomyocytes and cardiac conduction tissue leading to atrial fibrillation, ventricular tachycardia and dilated cardiomyopathy. LMNA mutations are one of the most common, severe and highly penetrant causes of dilated cardiomyopathy and sudden cardiac death. While it remains to be seen if this drug will significantly halt disease progression, targeted therapies based on for cardiomyopathies are on the rise.As physicians and scientist continue to identify the mechanisms behind development of cardiomyopathy and target these pathways directly eventually deliver the promise of precision medicine in cardiomyopathy. The next few years promise to be an exciting time for precision medicine in cardiology and beyond. This is just the beginning. HTPrecision medicine for cardiomyopathy is not limited to amyloidosis
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