Echocardiographic phenotype and prognosis in transthyretin cardiac amyloidosis

Eur Heart J. 2020 Apr 7;41(14):1439-1447. doi: 10.1093/eurheartj/ehz905.

Abstract

Aims: Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. We sought to characterize the structural and functional echocardiographic phenotype across the spectrum of wild-type (wtATTR-CM) and hereditary (hATTR-CM) transthyretin cardiomyopathy and the echocardiographic features predicting prognosis.

Methods and results: We studied 1240 patients with ATTR-CM who underwent prospective protocolized evaluations comprising full echocardiographic assessment and survival between 2000 and 2019, comprising 766 with wtATTR-CM and 474 with hATTR-CM, of whom 314 had the V122I variant and 127 the T60A variant. At diagnosis, patients with V122I-hATTR-CM had the most severe degree of systolic and diastolic dysfunction across all echocardiographic parameters and patients with T60AhATTR-CM the least; patients with wtATTR-CM had intermediate features. Stroke volume index, right atrial area index, longitudinal strain, and E/e' were all independently associated with mortality (P < 0.05 for all). Severe aortic stenosis (AS) was also independently associated with prognosis, conferring a significantly shorter survival (median survival 22 vs. 53 months, P = 0.001).

Conclusion: The three distinct genotypes present with varying degrees of severity. Echocardiography indicates a complex pathophysiology in which both systolic and diastolic function are independently associated with mortality. The presence of severe AS was independently associated with significantly reduced patient survival.

Keywords: Amyloidosis; Aortic stenosis; Cardiomyopathy; Echocardiography; Prognosis; Transthyretin.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amyloid Neuropathies, Familial* / diagnostic imaging
  • Amyloid Neuropathies, Familial* / genetics
  • Cardiomyopathies* / diagnostic imaging
  • Cardiomyopathies* / genetics
  • Echocardiography
  • Humans
  • Phenotype
  • Prealbumin / genetics
  • Prognosis
  • Prospective Studies

Substances

  • Prealbumin