Should ATTR-CM be added to the differential diagnosis of patients with HF?

Amyloidosis was determined to be the cause of heart failure (HF) in approximately 20% of the patients treated in the Internal Medicine departments of 24 Spanish hospitals in the PREVAMIC trial. According to the authors, transthyretin amyloid cardiomyopathy (ATTR-CM) should be included in the differential diagnosis of elderly patients with HF and myocardial thickening.

Dr Rocío Ruiz Hueso (University Hospital of Virgen Macarena, Spain) and colleagues aimed to assess the prevalence of cardiac amyloidosis (CA) in patients with HF and treated at the Internal Medicine departments of Spanish hospitals HF (PREVAMIC NCT04066452) [1]. They compared patient profiles between those with HF caused by CA and those with another cause of HF. The observational, prospective, cross-sectional, multicentre study included 453 patients with HF (≥65 years) who displayed left ventricular hypertrophy.

In total, 91 patients were diagnosed with CA, following the CA diagnostic algorithm of the ESC Working Group on Myocardial and Pericardial Diseases, resulting in a prevalence of 20.1% of the participants with CA, of which 84.6% had ATTR-CM and only 1.1% had primary amyloidosis [1,2]. According to Dr Ruiz Hueso, it was not possible to diagnose the CA type of the remaining 14.3% of the patients. At least 5.2% of the patients with ATTR-CM had a hereditary cause of the condition.

Participants diagnosed with CA were generally older (P<0.001) and more likely to be men (P=0.019). Also, participants with CA displayed higher rates of spinal stenosis (P=0.001), pericardial effusion (P<0.001), and aortic regurgitation (P=0.005), showed higher levels of NT-ProBNP (P=0.008) and troponin-T high sensitivity (P=0.01), and had a higher average left ventricular mass index (P=0.002).

Dr Ruiz Hueso concluded that ATTR-CM should be included in the differential diagnosis of patients with HF and myocardial thickening, irrespective of left ventricular ejection fraction. However, to establish the CA subtype correctly, invasive testing is needed when the results from non-invasive CA tests are inconclusive. Also, genetic tests are required if a patient is diagnosed with ATTR-CM.

1. Ruiz Hueso R, et al. Prevalence of cardiac amyloidosis in internal medicine patients with heart failure: PREVAMIC. Heart Failure Posters–Focus on Basic Science, Heart Failure 2022, 21–24 May, Madrid, Spain.
2. García-Pavía P, et al. Med Clin (Barc). 2021;156(3):126–134.

 

Copyright ©2022 Medicom Medical Publishers



Posted on 28 July, 2022