Geriatrics Department, Hospital Central de la Cruz Roja, Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, Spain.
Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, Spain; Cardiology Department, Hospital Central de la Cruz Roja, Madrid, Spain.
Rev Esp Geriatr Gerontol. 2023 Jan-Feb;58(1):8-14. doi: 10.1016/j.regg.2022.10.005. Epub 2022 Nov 18.
There is increased interest in studying ATTR-CA, a pathology that primarily affects patients of geriatric age and is frequently underdiagnosed. We aim to establish the prevalence of ATTR-CA in a cohort of patients with a history of HFpEF and to describe its characteristics.
We conducted a prospective observational study. Patients ≥75 years, clinical history of HFpEF, atrial dilation ≥34ml/m and left ventricular wall thickening >13mm, were included. Demographic and analytical parameters were collected, and a comprehensive geriatric assessment was performed, along with a transthoracic echocardiogram and cardiac scintigraphy. Finally, telephone follow-up was carried out at 6 and 12 months.
50 patients were recruited, mean age 86±6 years, 54% women. Age and functional class (I-II vs. III-IV) were factors associated with presenting with ATTR-CA. Patients with positive scintigraphy had a median time to admission of 5.2 months (confidence interval [CI] 95% 0-10.9), while in those with negative scintigraphy, it was 12.2 months (95% CI 11.7-12.8); log-rank: p=0.064. Patients with positive scintigraphy had a median time to the combined endpoint (death and readmission) of 1.9 months (95% CI 0-6.1), and patients with negative scintigraphy of 11.9 months (95% CI 11.7-12); log-rank: p=0.027.
ATTR-CA appears to be a prevalent etiology in elderly patients within the spectrum of HFpEF. Patients with a diagnosis of ATTR-CA had a shorter time to admission for HF and the combined event of death and admission than patients with a negative result on scintigraphy.
人们对研究主要影响老年患者且常被漏诊的ATTR-CA 病理学越来越感兴趣。本研究旨在确定伴有 HFpEF 病史患者队列中ATTR-CA 的患病率，并描述其特征。
我们进行了一项前瞻性观察性研究。纳入年龄≥75 岁、HFpEF 临床病史、心房扩张≥34ml/m 和左心室壁增厚>13mm 的患者。收集人口统计学和分析参数，并进行全面老年评估，同时进行经胸超声心动图和心脏闪烁显像。最后，在 6 个月和 12 个月时进行电话随访。
共纳入 50 例患者，平均年龄 86±6 岁，54%为女性。年龄和功能分级（I-II 级与 III-IV 级）是与ATTR-CA 表现相关的因素。闪烁显像阳性患者的入院中位时间为 5.2 个月（95%CI 95%置信区间为 0-10.9），而闪烁显像阴性患者的入院中位时间为 12.2 个月（95%CI 11.7-12.8）；对数秩检验：p=0.064。闪烁显像阳性患者的复合终点（死亡和再入院）中位时间为 1.9 个月（95%CI 95%置信区间为 0-6.1），闪烁显像阴性患者的中位时间为 11.9 个月（95%CI 11.7-12）；对数秩检验：p=0.027。
ATTR-CA 似乎是 HFpEF 谱内老年患者的常见病因。与闪烁显像阴性的患者相比，诊断为ATTR-CA 的患者因 HF 入院和死亡及入院复合事件的时间更短。
