Prevalence of Cardiac Amyloidosis Among Elderly Patients With Recent-Onset Atrial Fibrillation: The PREVAL-ATTR Study.

IF 5.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Canadian Journal of Cardiology Pub Date : 2024-10-16 DOI:10.1016/j.cjca.2024.10.010
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
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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 centres. ATTR-CA noninvasive screening was offered to patients ≥ 65 years of age recently diagnosed (< 1 year) with nonvalvular 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% confidence interval [CI],4-14.7%), were diagnosed with cardiac amyloidosis (CA): 5 with definite wild-type ATTR-CA (ATTRwt), 4 with likely ATTRwt, and 1 with undetermined CA. Compared with 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 N-terminal pro-B-type natriuretic peptide (NTproBNP) (3800 pg/L, interquartile range [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.

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近期发生心房颤动的老年患者中心脏淀粉样变性的患病率。PREVAL-ATTR 研究。
背景:转甲状腺素心脏淀粉样变性(ATTR-CA)越来越被认为是一种可治疗的心力衰竭形式。心房颤动(房颤)在 ATTR-CA 患者中很常见。近期发生的房颤是否可作为识别ATTR-CA患者的早期标志物尚未阐明:这是一项在 3 个西班牙中心进行的前瞻性研究。方法:这是一项在西班牙 3 个中心进行的前瞻性研究,为年龄≥65 岁、最近确诊为 ATTR-CA 的患者提供 ATTR-CA 无创筛查:共纳入 121 名患者(75% 为男性,平均年龄为 77±7 岁)。10名患者(8.3%,95%CI:4-14.7%)被确诊为心脏淀粉样变性(CA):5名确诊为野生型ATTR-CA(ATTRwt),4名可能为ATTRwt,1名CA未确定。与无CA的患者相比,CA患者年龄更大(84±4岁对76±7岁;P结论:对近期出现房颤、左心室功能不全和额外红旗的老年患者进行常规 DPD 扫描可能有助于识别 ATTR-CA 患者。然而,需要在更多样化的临床环境中对这一策略进行更大规模的评估研究。
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来源期刊
Canadian Journal of Cardiology
Canadian Journal of Cardiology 医学-心血管系统
CiteScore
9.20
自引率
8.10%
发文量
546
审稿时长
32 days
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.
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