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Prevalence of transthyretin cardiac amyloidosis in a community-based heart failure population

Session Dilated, infiltrative and inflammatory cardiomyopathies

Speaker Bjorn Pilebro

Event : ESC Congress 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Moderated Posters

Authors : K Lindmark (Umeå,SE), B Pilebro (Umeå,SE), L Solekrans (Umea,SE), J Wixner (Umeå,SE), I Anan (Umeå,SE), O Suhr (Umeå,SE), P Lindqvist (Umea,SE)

K. Lindmark1 , B. Pilebro1 , L. Solekrans2 , J. Wixner1 , I. Anan1 , O. Suhr1 , P. Lindqvist2 , 1Public Health and Clinical Medicine, Medicne - Umeå - Sweden , 2Umea University - Umea - Sweden ,

European Heart Journal ( 2019 ) 40 ( Supplement ), 132

Introduction: Cardiac wild type (wt) transthyretin (ATTR) amyloidos causes hypertrophic, restrictive cardiomyopathy in older patients and is generally considered underdiagnosed. However, its prevalence remains poorly investigated. Scintigraphy using bone tracers, e.g. Tc-PYP and Tc-DPD, is a highly sensitive and specific method for detection of cardiac ATTR and has revolutionised diagnostics The aim of this study was to describe the prevalence of wtATTR amyloidosis in our heart failure population.

Methods: Our University Hospital is the sole provider of specialised heart care in an area with around 150 000 inhabitants, 37 600 of which are older than 60 years. Medical records for all living patients in the area with a diagnosis of heart failure, hypertensive heart disease or cardiomyopathy between 2010 and May 2018 were scrutinized (n=2237). 95% of these patients had an echocardiographic exam available for re-evaluation. All patients withseptal thickness >14 mm who had no previous DPD scintigraphy or genetic diagnosis of sarcomeric hypertophic cardiomyopathy were offered DPD scintigraphy (n=131). Eight patients died prior to and 38 patients declined work up, mainly due to old age.

A DPD uptake of grade 2 or higher was considered diagnostic in absence of signs of AL amyloidosis.

Results: Adding up patients found during the screening effort and those with an already known diagnosis of wtATTR amyloidosis, 26 patients had wtATTR. Their men age was 84 years and 90% were male.

Conclusions: The study gives us an estimated prevalence of disease warranting specialized heart failure treatment of 1/1500 in the population older than 60 years. Cardiac wtATTR amyloidosis is common in patients with heart failure and increased LV wall thickness, especially among the older male patients. Therefore we recommend a liberal use of bone scintigraphy in this group.

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