Prevalence of transthyretin amyloidosis in patients with heart failure with preserved ejection fraction

Abstract

Abstract Background Heart failure with preserved ejection fraction (HFpEF) currently accounts for up to half of heart failure cases. Although transthyretin amyloidosis (ATTR) can cause HFpEF, the contribution of ATTR to the burden of HFpEF is poorly defined. Purpose To clarify the characteristics of ATTR and determine the prevalence of cardiac ATTR in patients with HFpEF. Methods This is a multicentre, prospective, observational study in Japan. We enrolled 373 HFpEF (HF+LVEF ≥50%+ 65 < years old) patients who admitted to the Departments of Cardiology from September 2018 to January 2022. A 99mTc-PYP scintigraphy was performed during admission in all eligible patients. The patients divided into 2 groups according to 99mTc-PYP scintigraphy positive (Grade2–3: n=53) or negative (Grade 0–1: n=320). Medical history, laboratory data, echocardiogram, hemodynamic data, treatments compared. Results A total of 55 patients (14.2%) showed a moderate to severe up take on the 99mPYP scintigraphy. An endomyocardial biopsy was performed in 32 patients confirming amyloidosis in all cases. There were no differences in age, gender, diabetes, coronary artery disease between the two groups. Although patients with positive PYP group exhibited higher N-terminal pro-brain natriuretic peptide [3.0 (1.7–4.6) vs 3.4 (2.4–4.2); P<0.001)], high sensitive troponin T (0.035±0.038 vs 0.074±0.049; P<0.001), mean left ventricle maximal wall thickness (10.5±1.9 vs 12.5±2.2; P<0.001), clinical overlap between ATTR and other HFpEF forms was high. Conclusion ATTR is a disease with significant prevalence in Japanese patients with HFpEF Funding Acknowledgement Type of funding sources: None.