Shankar Bairavi, Yanek Lisa, Jefferson Artrish, Jani Vivek, Brown Emily, Tsottles Daniel, Barranco Jennifer, Zampino Serena, Ranek Mark, Sharma Kavita, Polydefkis Michael, Vaishnav Joban
Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
JACC CardioOncol. 2024 Jun 18;6(3):454-463. doi: 10.1016/j.jaccao.2024.05.001. eCollection 2024 Jun.
Transthyretin amyloid cardiomyopathy (ATTR-CM) is associated with significant mortality. The Val122Ile variant, highly prevalent in Black patients, portends poorer survival compared with other ATTR-CM subtypes. Although Val122Ile is biologically more aggressive, the contribution of race and socioeconomic status (SES) to disease outcomes in patients with ATTR-CM is undefined.
The aim of this study was to evaluate the impact of race and SES on clinical outcomes in patients with ATTR-CM.
Patients with ATTR-CM who received care at Johns Hopkins Hospital between 2006 and 2022 were included. SES was assessed using area deprivation index (ADI). Associations of race and ADI with heart failure (HF) hospitalization and/or death were measured using multivariable logistic or Cox proportional hazards models.
Of 282 patients, 225 (80%) were men, and 129 (46%) were Black. Black vs White patients disproportionately constituted the highest ADI (most deprived) category (66% vs 28%; = 0.004), and Black patients were more likely to have HF hospitalization or death over 5 years compared with White patients (log-rank < 0.001). Among those with ADI >25, Black patients had a significantly greater hazard of HF hospitalization or death compared with White patients, independent of disease stage at diagnosis (HR: 2.77; 95% CI: 1.45-5.32; = 0.002).
Black patients with low SES may be at greater risk for underdiagnosis and adverse outcomes compared with White patients. Ongoing efforts are needed to improve outcomes in this subset of patients with ATTR-CM.
转甲状腺素蛋白淀粉样变心肌病（ATTR-CM）与显著的死亡率相关。Val122Ile变异在黑人患者中高度流行，与其他ATTR-CM亚型相比，其生存预后更差。尽管Val122Ile在生物学上更具侵袭性，但种族和社会经济地位（SES）对ATTR-CM患者疾病转归的影响尚不清楚。
本研究旨在评估种族和SES对ATTR-CM患者临床结局的影响。
纳入2006年至2022年在约翰霍普金斯医院接受治疗的ATTR-CM患者。使用地区贫困指数（ADI）评估SES。使用多变量逻辑回归或Cox比例风险模型测量种族和ADI与心力衰竭（HF）住院和/或死亡的关联。
282例患者中，225例（80%）为男性，129例（46%）为黑人。与白人患者相比，黑人患者不成比例地构成了最高ADI（最贫困）类别（66%对28%；P = 0.004），并且与白人患者相比，黑人患者在5年内更有可能发生HF住院或死亡（对数秩P < 0.001）。在ADI>25的患者中，与白人患者相比，黑人患者发生HF住院或死亡的风险显著更高，与诊断时的疾病阶段无关（HR：2.77；95%CI：1.45-5.32；P = 0.002）。
与白人患者相比，SES较低的黑人患者可能面临更大的漏诊风险和不良结局。需要持续努力改善这一亚组ATTR-CM患者的结局。
