Phenotype and prognostic factors in geriatric and non‐geriatric patients with transthyretin cardiomyopathy

Author:

Volpentesta Eugenia12,Kharoubi Mounira3456,Donadio Cristiano2,Rebiai Kahina34,Fanen Pascale7,Funalot Benoit57,Gendre Thierry89,Audard Vincent910,Canoui‐Poitrine Florence61112,Itti Emmanuel91314,Teiger Emmanuel3456,Planté‐Bordeneuve Violaine89,Oghina Silvia34,Tixier Denis34,Mallet Sophie34,Broussier Amaury1115,Damy Thibaud345611ORCID,Zaroui Amira345611

Affiliation:

1. Departement of Geriatrics, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri‐Mondor/Albert‐Chenevier Hospital Créteil France

2. Departement of Geriatrics, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Charles Foix Hospital Ivry‐sur‐seine France

3. Department of Cardiology, AP‐HP (Assistance Publique‐Hôpitaux de Paris), DMU Care Henri Mondor University Hospital Créteil France

4. Cardiac Amyloidosis Referral Centre, Cardiogen Network, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri Mondor University Hospital Créteil France

5. GRC Amyloid Research Institute, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri Mondor University Hospital Créteil France

6. DHU A‐TVB, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri Mondor University Hospital Créteil France

7. Department of Genetics, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri Mondor University Hospital Créteil France

8. Department of Neurology, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri Mondor University Hospital Créteil France

9. Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB) University Paris Est Créteil Créteil France

10. Department of Nephrology and Renal Transplantation, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri Mondor University Hospital Créteil France

11. Clinical Epidemiology and Ageing (CEpiA) Geriatrics Primary Care and Public Health Créteil France

12. Department of Public Health Department, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri Mondor University Hospital Créteil France

13. Department of Nuclear Medicine, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri Mondor University Hospital Créteil France

14. Clinical Investigation Center 1430, AP‐HP (Assistance Publique‐Hôpitaux de Paris) Henri Mondor University Hospital Créteil France

15. Department of Geriatrics AP‐HP, Hopitaux Henri‐Mondor/Emile Roux Limeil‐Brevannes France

Abstract

AbstractAimsTransthyretin cardiac amyloidosis (ATTR‐CM) may be an underestimated cause of heart failure among geriatric patients and represent a unique phenotype and prognostic profile.Methods and resultsThis retrospective, observational, cohort study characterizes cardiac and extracardiac disorders at diagnosis and assesses prognosis among ATTR‐CM patients based on age (geriatric vs. non‐geriatric) and amyloidosis subtype (wild type, ATTRwt and hereditary, ATTRv). In total, 943 patients with ATTR‐CM were included, of which 306 had ATTRv and 637 had ATTRwt. Among these, 331 (35.1%) were non‐geriatric (<75 years), and 612 (64.9%) were geriatric (≥75 years). The population exhibited conduction abnormalities, atrial fibrillation and ischaemic heart disease that progressively deteriorated with age. Among ATTRwt patients, peripheral neuropathy, neurovegetative symptoms, and hearing loss were present across all age groups, but reports of carpal tunnel symptoms or surgery decreased with age. Conversely, among ATTRv patients, reports of extracardiac symptoms increased with age and Val122ILe mutation was highly prevalent among geriatric patients. The 3‐year survival was higher among non‐geriatric ATTR‐CM patients (76%) than geriatric patients (55%) and predictors of 3‐year mortality differed. Notably, predictors identified among geriatric patients were alkaline phosphatase (ALP) (HR = 1.004, 95% CI: [0.001–1.100)], troponin T hs (HR = 1.005, 95% CI: [1.001–1.120)] and tricuspid insufficiency (HR = 1.194, 95% CI: [1.02–1.230)]. Whereas, among non‐geriatric patients, NT‐proBNP (HR = 1.002, 95% CI: [1.02–1.04], global longitudinal strain (HR = 0.95, 95% CI: [0.922–0.989], and glomerular filtration rate (HR = 0.984, 95% CI: [0.968–1.00) were identified. We propose a 3‐stage prognostic staging system combining troponin T hs (≥44 ng/L) and ALP levels (≥119 UI/L). In the geriatric population, this model discriminated survival more precisely than the National Amyloidosis Centre staging, particularly for classifying between stage 1 (82%), stage 2 (50%) and stage 3 (32%) for ATTRv and ATTRwt.ConclusionsThese diagnostic and prognostic indicators, along with ATTR subtype, highlight the distinct characteristics of this important, geriatric ATTR‐CM patient group. Recognizing these mortality markers can be valuable for geriatricians to improve the prognostic quality management of geriatric patients with ATTR‐CM.

Publisher

Wiley

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