Characterization of hereditary transthyretin cardiac amyloidosis in Spain

Rev Esp Cardiol (Engl Ed). 2022 Jun;75(6):488-495. doi: 10.1016/j.rec.2021.07.020. Epub 2021 Oct 26.
[Article in English, Spanish]

Abstract

Introduction and objectives: Hereditary transthyretin amyloidosis (hATTR) is a disease caused by mutations in the transthyretin gene that frequently shows cardiac involvement due to amyloid deposition in the myocardium. Our objective was to identify cardiac involvement in a Spanish cohort.

Methods: Retrospective multicenter study of patients diagnosed with hATTR with cardiac involvement from Spanish centers. We collected demographic, clinical, and genetic data.

Results: A total of 181 patients from 26 centers were included (65.2% men, with a median age at diagnosis of 62 years). The most frequent mutations were Val50Met (67.7%) and Val142Ile (12.4%). The main reason for consultation was extracardiac symptoms (69%), mainly neurological. The mean N-terminal pro-B-type natriuretic peptide level was 2145±3586 pg/mL. The most characteristic electrocardiogram findings were a pseudoinfarct pattern (25.9%) and atrioventricular block (25.3%). Mean ventricular thickness was 15.4±4.1mm. Longitudinal strain was reduced in basal segments by 29.4%. Late diffuse subendocardial enhancement was observed in 58.8%. Perugini grade 2 or 3 uptake was observed in 75% of scintigraphy scans. During follow-up, 24.9% of the patients were admitted for heart failure, 34.3% required a pacemaker, and 31.6% required a liver transplant. One third (32.5%) died during follow-up, mainly due to heart failure (28.8%). The presence of non-Val50Met mutations was associated with a worse prognosis.

Conclusions: HATTR cardiac amyloidosis in Spain shows heterogeneous genetic and clinical involvement. The prognosis is poor, mainly due to cardiac complications. Consequently early diagnosis and treatment are vital.

Keywords: Amiloidosis cardiaca; Amiloidosis por transtirretina; Cardiac amyloidosis; Prognosis; Pronóstico; Transthyretin; Transthyretin amyloidosis; Transtirretina; Tratamiento; Treatment.

Publication types

  • Multicenter Study

MeSH terms

  • Amyloid Neuropathies, Familial* / diagnosis
  • Amyloid Neuropathies, Familial* / epidemiology
  • Amyloid Neuropathies, Familial* / genetics
  • Cardiomyopathies* / diagnosis
  • Cardiomyopathies* / epidemiology
  • Cardiomyopathies* / genetics
  • Female
  • Heart Failure* / complications
  • Humans
  • Male
  • Middle Aged
  • Prealbumin / genetics
  • Spain / epidemiology

Substances

  • Prealbumin

Supplementary concepts

  • Amyloidosis, Hereditary, Transthyretin-Related