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Introduction:
Limited data are available regarding the clinical value of hepatobiliary markers in transthyretin amyloid cardiomyopathy (ATTR-CM). Gamma-glutamyltransferase (GGT) is recognized as a marker of cardiohepatic syndrome and is associated with impaired hemodynamics and poor prognosis in chronic heart failure. We therefore hypothesized that serum GGT may serve as a prognostic indicator in patients with ATTR-CM.

Methods:
This single-center retrospective study evaluated 110 consecutive patients diagnosed with ATTR-CM between 2014 and 2022 at our institution. Three patients were excluded due to missing data, leaving 107 patients for analysis. Prognostic follow-up began at the time of diagnosis. Adverse events were defined as the composite endpoint of all-cause mortality or heart failure hospitalization.

Results:
The mean age of the study population was 78.5 [73.8-81.9] years, and 94 patients (88%) were male. The median GGT level was 62 [30-100] U/L. Patients with the highest GGT tertile (≧ 92 U/L; N=34), compared with those in the lower tertiles, had a larger inferior vena cava diameter and lower cardiac output on echocardiography (all P<0.05). During a median follow-up of 3.7 [2.0-5.9] years, the composite endpoint occurred in 45 patients. By Kaplan-Meier analysis, a higher GGT level was associated with lower event-free survival (Figure 1). Cox proportional hazards analysis demonstrated that serum GGT level at diagnosis was an independent predictor of the composite end point, even after adjustment for established prognostic markers used in amyloidosis staging (including serum troponin T, B-type natriuretic peptide, and estimated glomerular filtration rate) and use of disease-modifying therapy for ATTR-CM (Figure 2).

Conclusions:
Serum GGT was a significant predictor of all‑cause mortality or heart failure hospitalization in patients with ATTR‑CM.

Prognostic impact of gamma-glutamyltransferase in transthyretin amyloid cardiomyopathy

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Doctor Asuka Kuwahara

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ePosters in myocardial disease (6)

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Heart Failure 2026

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