Abstract：
OBJECTIVE: Transthyretin cardiac amyloidosis (ATTR-CA) is a frequent cause of heart failure with preserved ejection fraction (HFpEF). This study sought to determine the prevalence of ATTR-CA among HFpEF patients in a multicenter nationwide study.
METHODS: Consecutive ambulatory or hospitalized patients aged ≥ 50 years with HFpEF and left ventricle hypertrophy ≥ 12mm were studied at 20 Spanish hospitals. Screening for cardiac amyloidosis was initiated according to the usual clinical practice of each center. Positive scintigraphs were centrally analyzed.
RESULTS: 422 patients were included, of whom 387 underwent further screening for cardiac amyloidosis. A total of 65 patients (16.8%) were diagnosed with ATTR-CA, none below 75 years. There was an increase of prevalence with age. Of them, 60% were male, with a mean age of 85.3±5.2 years, mean left ventricle ejection fraction of 60.3±7.6% and a mean maximum left ventricle wall thickness of 17.2 [12-25] mm. Most of the patients were New York Heart Association class II (48.4%) or III (46.8%). Besides being older than non-ATTR-CA patients, ATTR-CA patients had higher median NT-proBNP levels (3801 [2266-7132] vs 2391 [1141-4796] pg/mL; P=.003). There was no statistical difference in the prevalence of ATTR-CA by sex (19.7% for men and 13.8% for women, P=.085). A ∼7% (4/56) of the patients exhibited a genetic variant (ATTRv).
CONCLUSIONS: This multicenter nationwide study found a prevalence of 16.8%, confirming that ATTR-CA is a significant contributor to HFpEF in male and female patients with left ventricle hypertrophy and more than 75 years.
METHODS: Consecutive ambulatory or hospitalized patients aged ≥ 50 years with HFpEF and left ventricle hypertrophy ≥ 12mm were studied at 20 Spanish hospitals. Screening for cardiac amyloidosis was initiated according to the usual clinical practice of each center. Positive scintigraphs were centrally analyzed.
RESULTS: 422 patients were included, of whom 387 underwent further screening for cardiac amyloidosis. A total of 65 patients (16.8%) were diagnosed with ATTR-CA, none below 75 years. There was an increase of prevalence with age. Of them, 60% were male, with a mean age of 85.3±5.2 years, mean left ventricle ejection fraction of 60.3±7.6% and a mean maximum left ventricle wall thickness of 17.2 [12-25] mm. Most of the patients were New York Heart Association class II (48.4%) or III (46.8%). Besides being older than non-ATTR-CA patients, ATTR-CA patients had higher median NT-proBNP levels (3801 [2266-7132] vs 2391 [1141-4796] pg/mL; P=.003). There was no statistical difference in the prevalence of ATTR-CA by sex (19.7% for men and 13.8% for women, P=.085). A ∼7% (4/56) of the patients exhibited a genetic variant (ATTRv).
CONCLUSIONS: This multicenter nationwide study found a prevalence of 16.8%, confirming that ATTR-CA is a significant contributor to HFpEF in male and female patients with left ventricle hypertrophy and more than 75 years.
摘要：
目的：转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）是射血分数保留的心力衰竭（HFpEF）的常见原因。本研究旨在在一项多中心的全国性研究中确定HFpEF患者中ATTR-CA的患病率。
方法：在西班牙20家医院研究了年龄≥50岁的HFpEF和左心室肥厚≥12mm的连续门诊或住院患者。根据每个中心的常规临床实践开始CA筛查。对阳性闪烁显像进行集中分析。
结果：共纳入422例患者，其中387人接受了进一步的CA筛查。65例患者（16.8%）被诊断为ATTR-CA，没有一个小于75岁。患病率随年龄增长而增加。在这些患者中,60%是男性,平均年龄85.3±5.2岁，平均左心室射血分数为60.3±7.6%，和平均最大左心室壁厚17.2（范围，12-25)mm。大多数患者为纽约心脏协会II级（48.4％）或III级（46.8％）。除了比没有ATTR-CA的患者年龄大，ATTR-CA患者的NT-proBNP中位数水平较高(3801[2266-7132]vs2391[1141-4796]pg/mL;P=.003).ATTR-CA的患病率按性别分类差异无统计学意义(男性为19.7%,女性为13.8%,P=.085）。在大约7%(4/56)的患者中发现了遗传变异(ATTRv)。
结论：这项全国性的多中心研究发现，ATTR-CA的患病率为16.8％，确认它是75岁以上男女左心室肥厚患者HFpEF的重要原因。
方法：在西班牙20家医院研究了年龄≥50岁的HFpEF和左心室肥厚≥12mm的连续门诊或住院患者。根据每个中心的常规临床实践开始CA筛查。对阳性闪烁显像进行集中分析。
结果：共纳入422例患者，其中387人接受了进一步的CA筛查。65例患者（16.8%）被诊断为ATTR-CA，没有一个小于75岁。患病率随年龄增长而增加。在这些患者中,60%是男性,平均年龄85.3±5.2岁，平均左心室射血分数为60.3±7.6%，和平均最大左心室壁厚17.2（范围，12-25)mm。大多数患者为纽约心脏协会II级（48.4％）或III级（46.8％）。除了比没有ATTR-CA的患者年龄大，ATTR-CA患者的NT-proBNP中位数水平较高(3801[2266-7132]vs2391[1141-4796]pg/mL;P=.003).ATTR-CA的患病率按性别分类差异无统计学意义(男性为19.7%,女性为13.8%,P=.085）。在大约7%(4/56)的患者中发现了遗传变异(ATTRv)。
结论：这项全国性的多中心研究发现，ATTR-CA的患病率为16.8％，确认它是75岁以上男女左心室肥厚患者HFpEF的重要原因。
