Sex Differences in Transthyretin Cardiac Amyloidosis: Unraveling the Complexities in Epidemiology, Pathophysiology, Diagnosis, and Treatment.

IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Current Heart Failure Reports Pub Date : 2024-08-01 Epub Date: 2024-05-22 DOI:10.1007/s11897-024-00667-9
Silvia Vilches, María Martínez-Avial, Irene Méndez, Cristina Gómez González, María Ángeles Espinosa
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Abstract

Transthyretin cardiac amyloidosis (ATTR-CA) is characterised by the deposition of transthyretin amyloid fibrils in the heart. ATTR-CA affects both men and women although there is evidence of sex differences in prevalence and clinical presentation. PURPOSE OF REVIEW: This review paper aims to comprehensively examine and synthesise the existing literature on sex differences in ATTR-CA. RECENT FINDINGS: The prevalence of ATTR-CA is higher in males although the male predominance is more apparent in older patients in the wild type form and in TTR genetic variants that predominantly result in a cardiac phenotype in the hereditary variant. Women tend to have less left ventricular hypertrophy (LVH) and a higher ejection fraction at clinical presentation which may contribute to a later diagnosis although the prognosis appears to be similar in both sexes. Female sex is a predictor of a good response to tafamidis 20 mg in TTR polyneuropathy but otherwise there are no data on sex differences in the efficacy of other treatments for ATTR-CA. It is crucial to define specific sex differences in ATTR-CA. A lower cut-off value for LVH in women may be needed to improve diagnosis. It is necessary to increase female representation in clinical trials to better understand possible sex differences in therapeutic management.

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转甲状腺素心脏淀粉样变性的性别差异:揭开流行病学、病理生理学、诊断和治疗的复杂面纱》。
转甲状腺素心脏淀粉样变性(ATTR-CA)的特征是转甲状腺素淀粉样纤维沉积在心脏中。虽然有证据表明 ATTR-CA 在发病率和临床表现上存在性别差异,但男女均可患病。综述目的:本综述旨在全面研究和总结有关 ATTR-CA 性别差异的现有文献。最新发现:ATTR-CA 的发病率在男性中较高,但在野生型和 TTR 基因变异型中,男性在老年患者中的优势更为明显,在遗传变异型中,男性主要导致心脏表型。女性在临床表现时左心室肥厚(LVH)程度较轻,射血分数较高,这可能会导致诊断较晚,但男女患者的预后似乎相似。女性是TTR多发性神经病患者对他法米地20毫克治疗反应良好的一个预测因素,但除此之外,尚无其他治疗ATTR-CA疗效方面性别差异的数据。确定 ATTR-CA 的具体性别差异至关重要。可能需要降低女性 LVH 的临界值,以提高诊断率。有必要增加女性在临床试验中的代表性,以更好地了解治疗管理中可能存在的性别差异。
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来源期刊
Current Heart Failure Reports
Current Heart Failure Reports Medicine-Emergency Medicine
CiteScore
5.30
自引率
0.00%
发文量
44
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of heart failure. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as investigative, pharmacologic, and nonpharmacologic therapies, pathophysiology, and prevention. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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