Open Access

Hypertension is associated with more advanced heart failure in african americans with suspected cardiac amyloidosis

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Date: 3 October 2022
Journal: European Heart Journal , Volume 43 , Issue Supplement_2
Authors: S. Manjunath , E. Deych , D. Lenihan , K. Zhang

ESC Journals

AbstractBackground

Prior studies have shown worse clinical outcomes for African Americans with transthyretin and light chain cardiac amyloidosis as compared to Caucasians. Hypertensive heart disease is common among African Americans, and a known echocardiographic mimic of cardiac amyloidosis. The association between hypertension and heart failure severity in patients with suspected cardiac amyloidosis has not been well characterized.

Purpose

We sought to identify phenotypic differences between African American and Caucasian patients with suspected cardiac amyloidosis with and without hypertension.

Methods

We retrospectively identified consecutive patients who underwent cardiac biopsy for evaluation of cardiac amyloidosis at our institution between 2000–2018. Clinical and demographic data were obtained from the medical record. Electrocardiograms and echocardiograms performed at the time of cardiac biopsy were interpreted by study personnel.

Results

Among 230 patients with suspected cardiac amyloidosis, 144 (58%) had a prior diagnosis of hypertension. Hypertension was more common among African Americans (71 of 91, 78%) than among Caucasians (73 of 139, 52%). Among African Americans with suspected cardiac amyloidosis, those with hypertension had higher left ventricular mass index (156 versus 119 g/m2), lower left ventricular ejection fraction (47% versus 56%), worse global longitudinal strain (−9.0% versus −11.7%), and higher creatine (1.95 versus 1.43 mg/dL) than those without hypertension (p<0.05 for all). There were no differences in these parameters among Caucasians with and without hypertension.

Conclusions

Among African Americans with suspected cardiac amyloidosis, those with hypertension had worse systolic function and more advanced heart failure than those without hypertension. Targeted screening and/or surveillance strategies are needed to improve early diagnosis of cardiac amyloidosis in African American patients with hypertension.

Funding Acknowledgement

Type of funding sources: None.

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About the contributors

S Manjunath

Role: Author

E Deych

Role: Author

D J Lenihan

Role: Author