Paloma Remior-Pérez, Miriam Gómez-Molina, Daniel García-Rodríguez, María Gallego-Delgado, Laroussi Mohamed-Salem, Javier de Haro-Del Moral, Fernando Hernández-Terciado, Daniel de Castro, Rocio Eiros-Bachiller, Fernando Dominguez, Esther Gonzalez-Lopez, Eduardo Villacorta, Domingo A Pascual-Figal, Pablo Garcia-Pavia
{"title":"Prevalence of cardiac amyloidosis among elderly patients with recent-onset atrial fibrillation. The PREVAL-ATTR study.","authors":"Paloma Remior-Pérez, Miriam Gómez-Molina, Daniel García-Rodríguez, María Gallego-Delgado, Laroussi Mohamed-Salem, Javier de Haro-Del Moral, Fernando Hernández-Terciado, Daniel de Castro, Rocio Eiros-Bachiller, Fernando Dominguez, Esther Gonzalez-Lopez, Eduardo Villacorta, Domingo A Pascual-Figal, Pablo Garcia-Pavia","doi":"10.1016/j.cjca.2024.10.010","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Transthyretin cardiac amyloidosis (ATTR-CA) is increasingly recognized as a treatable form of heart failure. Atrial fibrillation (AF) is common in patients with ATTR-CA. Whether recent-onset AF can be used as an early marker to identify patients with ATTR-CA has not been elucidated.</p><p><strong>Methods: </strong>This was a prospective study conducted at 3 Spanish centers. ATTR-CA noninvasive screening was offered to patients ≥65 years old recently diagnosed (<1 year) with non-valvular AF and who had ≥1 echocardiographic, electrocardiographic or clinical sign suggestive of ATTR-CA.</p><p><strong>Results: </strong>A total of 121 patients were included (75% male, mean age 77±7 years). Ten patients (8.3%, 95%CI:4-14.7%), were diagnosed with cardiac amyloidosis (CA): 5 with definite wild-type ATTR-CA (ATTRwt), 4 with likely ATTRwt and one with undetermined CA. Compared to patients without CA, patients with CA were older (84±4 vs. 76±7 years;p<0.001), more frequently men (90% vs. 59%; p=0.047), presented higher median NTproBNP (3800 pg/L, IQR:1682-6101 vs. 1048 pg/mL, IQR:427-3154;p=0.017) and higher left ventricular hypertrophy (LVH) (14 mm, IQR:13-17 vs. 12 mm, IQR:12-13;p=0.003). Patients with CA also showed higher rate of permanent AF (90% vs. 49.5%;p=0.018) and a greater need for pacemaker implantation during follow-up (30% vs. 7.3%;p=0.049). No differences in mortality were observed between patients with and without CA after a median follow-up of 13 months (IQR:11-16 months).</p><p><strong>Conclusions: </strong>Routine DPD scanning in elderly patients with recent-onset AF, LVH and an additional red flag may help to identify patients with ATTR-CA. However, larger studies evaluating this strategy in more diverse clinical settings would be required.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":5.8000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cjca.2024.10.010","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Transthyretin cardiac amyloidosis (ATTR-CA) is increasingly recognized as a treatable form of heart failure. Atrial fibrillation (AF) is common in patients with ATTR-CA. Whether recent-onset AF can be used as an early marker to identify patients with ATTR-CA has not been elucidated.
Methods: This was a prospective study conducted at 3 Spanish centers. ATTR-CA noninvasive screening was offered to patients ≥65 years old recently diagnosed (<1 year) with non-valvular AF and who had ≥1 echocardiographic, electrocardiographic or clinical sign suggestive of ATTR-CA.
Results: A total of 121 patients were included (75% male, mean age 77±7 years). Ten patients (8.3%, 95%CI:4-14.7%), were diagnosed with cardiac amyloidosis (CA): 5 with definite wild-type ATTR-CA (ATTRwt), 4 with likely ATTRwt and one with undetermined CA. Compared to patients without CA, patients with CA were older (84±4 vs. 76±7 years;p<0.001), more frequently men (90% vs. 59%; p=0.047), presented higher median NTproBNP (3800 pg/L, IQR:1682-6101 vs. 1048 pg/mL, IQR:427-3154;p=0.017) and higher left ventricular hypertrophy (LVH) (14 mm, IQR:13-17 vs. 12 mm, IQR:12-13;p=0.003). Patients with CA also showed higher rate of permanent AF (90% vs. 49.5%;p=0.018) and a greater need for pacemaker implantation during follow-up (30% vs. 7.3%;p=0.049). No differences in mortality were observed between patients with and without CA after a median follow-up of 13 months (IQR:11-16 months).
Conclusions: Routine DPD scanning in elderly patients with recent-onset AF, LVH and an additional red flag may help to identify patients with ATTR-CA. However, larger studies evaluating this strategy in more diverse clinical settings would be required.
期刊介绍:
The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.