Abstract
Objective
Wild-type transthyretin amyloidosis cardiomyopathy (ATTRwt-CM) is increasingly recognized as a contributing factor to cardiac insufficiency in the elderly population. We aimed to identify the factors affecting age of onset of ATTRwt-CM, encompassing the assessment of amyloid deposition in myocardial tissue through the use of 99mTc-pyrophosphate (PYP) and clinical parameters.
Methods
A retrospective investigation involving a consecutive cohort of 107 cases, each having been diagnosed with ATTRwt-CM confirmed through histopathological and genetic analysis. All patients underwent PYP scintigraphy and the heart to contralateral (H/CL) ratio was calculated to measure amyloid deposition in the myocardium. Univariate and multivariate analysis were performed to identify independent predictors of the age of onset of ATTRwt-CM, considering the H/CL ratio and various clinical risk factors for heart failure.
Results
Gender (p = 0.029), Creatinine (Cr) (r = 0.315, p < 0.001), hemoglobin (Hb) (r = -0.437, p < 0.001), albumin (Alb) (r = -0.318, p < 0.001), brain natriuretic peptide (BNP) (r = 0.214, p = 0.028), low density lipoprotein-cholesterol (LDL-C) (r = -0.267, p = 0.006), and H/CL ratio (r = -0.439, p < 0.001) were all significantly associated with the onset age. In multiple regression analysis, the independent predictive factors for the onset age of ATTRwt-CM were identified as the H/CL ratio (p < 0.001), Hb (p = 0.003), and Cr (p = 0.018).
Conclusions
The H/CL ratio, Hb, and Cr independently affect age of onset in patients with ATTRwt-CM. The H/CL ratio is inversely correlated with age of onset, and may be the sole factor in the development of heart failure in early-onset patients, while it may have a synergistic effect on heart failure with anemia and renal dysfunction in late-onset patients.