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":"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。","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 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.</p><p><strong>Results: </strong>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).</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":" ","pages":""},"PeriodicalIF":5.8000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"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 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.</p><p><strong>Results: </strong>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).</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\":\" \",\"pages\":\"\"},\"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\":\"88\",\"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}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Cardiology","FirstCategoryId":"88","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}
Prevalence of Cardiac Amyloidosis Among Elderly Patients With Recent-Onset Atrial Fibrillation: The PREVAL-ATTR Study.
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.
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.