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

Presented by
Dr Rocío Ruiz Hueso, University Hospital of Virgen Macarena, Spain
HFA 2022

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. 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 who had HF and were treated at the Internal Medicine departments of Spanish hospitals HF (PREVAMIC NCT04066452) [1]. They also compared patient profiles between those whose HF was 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 patients with CA, 84.6% had ATTR-CM, whereas 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.

Furthermore, patients who were diagnosed with AC were generally older (P<0.001) and were more likely to be men (P=0.019). Also, patients 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 internal medicine 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 testing 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. ePosters focus on Basic Science, Heart Failure 2022, 21–24 May, Madrid, Spain.

    2. García Pavía P, et al. Med Clin (Barc) 2021;156:126–134.


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