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Background: The outcomes of patients with heart failure and preserved ejection fraction (HFpEF) have remained largely unchanged. Myocardial transthyretin amyloid deposition (ATTR) has been found in autopsy studies in up to 30% of patients with HFpEF. The 99mTc-pyrophosphate scintigraphy (PYP) scan can detect the presence of ATTR with high sensitivity and specificity. We hypothesized that in these patients the prevalence of ATTR as detected by the PYP scan is higher than previously described.
Methods: All patients with heart failure and a left ventricular ejection fraction ≥ 50% that had an echocardiogram and a PYP scan, were retrospectively analyzed. Echocardiographic and clinical variables were gathered in all the subjects. The diagnostic criteria for ATTR was a heart-to-contralateral (H:Cl) ratio of ≥ 1.5; while a ratio of < 1.5 was consistent with light-chain (AL) amyloidosis.
Results: The PYP scan was positive in 11/45 (24%) patients, of which 6 (55%) had H:Cl ratio < 1.5. Only 2/11 (18%) patients had histologic confirmation. Subgroup analysis of patients with a positive scan showed that dyspnea was the most predominant symptom 6/11 (55%) and low voltage electrocardiogram criteria was identified in 2 cases (18%). Patients with amyloid deposition were older (82±7 vs. 73±14 years, p 0.03), had a lower systolic blood pressure (129±18 vs. 149±33 mmHg, p 0.014), and left ventricular ejection fraction (55±7 vs. 60±6 %, p 0.03). Both groups had at least moderate left ventricular hypertrophy (median left ventricular wall thickness 1.5 cm, IQR 1.4-1.7 cm) with no significant difference between groups. An abnormal global longitudinal strain was observed in both groups (median GLS score 11.6, IQR 10.08-15.73). Patients with amyloid deposition had a significantly lower GLS score (median GLS score 9.8, IQR 7.3-10.73 vs. 12.53, IQR 11.23-16.15, p 0.002).
Conclusions: Cardiac amyloidosis, including the ATTR type, is an underestimated cause of HFpEF, which can be easily identified with the use of the PYP scan. These patients tend to be older and have worse systolic and diastolic left ventricular function. These findings create an opportunity for further investigation in the targeted therapy of patients with HFpEF.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-270
- 2017 American College of Cardiology Foundation