García-Pavía Pablo, García-Pinilla José Manuel, Lozano-Bahamonde Ainara, Yun Sergi, García-Quintana Antonio, Gavira-Gómez Juan José, Aibar-Arregui Miguel Ángel, Barge-Caballero Gonzalo, Núñez Villota Julio, Bernal Laura, Tarilonte Patricia
Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, Málaga, Spain.
Rev Esp Cardiol (Engl Ed). 2025 Apr;78(4):301-310. doi: 10.1016/j.rec.2024.07.005. Epub 2024 Jul 31.
Transthyretin cardiac amyloidosis (ATTR-CA) is a frequent cause of heart failure with preserved ejection fraction (HFpEF). This study sought to determine the prevalence of ATTR-CA among HFpEF patients in a multicenter nationwide study.
Consecutive ambulatory or hospitalized patients aged ≥ 50 years with HFpEF and left ventricle hypertrophy ≥ 12mm were studied at 20 Spanish hospitals. Screening for cardiac amyloidosis was initiated according to the usual clinical practice of each center. Positive scintigraphs were centrally analyzed.
422 patients were included, of whom 387 underwent further screening for cardiac amyloidosis. A total of 65 patients (16.8%) were diagnosed with ATTR-CA, none below 75 years. There was an increase of prevalence with age. Of them, 60% were male, with a mean age of 85.3±5.2 years, mean left ventricle ejection fraction of 60.3±7.6% and a mean maximum left ventricle wall thickness of 17.2 [12-25] mm. Most of the patients were New York Heart Association class II (48.4%) or III (46.8%). Besides being older than non-ATTR-CA patients, ATTR-CA patients had higher median NT-proBNP levels (3801 [2266-7132] vs 2391 [1141-4796] pg/mL; P=.003). There was no statistical difference in the prevalence of ATTR-CA by sex (19.7% for men and 13.8% for women, P=.085). A ∼7% (4/56) of the patients exhibited a genetic variant (ATTRv).
This multicenter nationwide study found a prevalence of 16.8%, confirming that ATTR-CA is a significant contributor to HFpEF in male and female patients with left ventricle hypertrophy and more than 75 years.
转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）是射血分数保留的心力衰竭（HFpEF）的常见病因。本研究旨在通过一项全国多中心研究确定ATTR-CA在HFpEF患者中的患病率。
在西班牙的20家医院对年龄≥50岁、患有HFpEF且左心室肥厚≥12mm的连续门诊或住院患者进行研究。根据各中心的常规临床实践启动心脏淀粉样变性筛查。对阳性闪烁扫描结果进行集中分析。
纳入422例患者，其中387例接受了进一步的心脏淀粉样变性筛查。共有65例患者（16.8%）被诊断为ATTR-CA，年龄均不低于75岁。患病率随年龄增加。其中，60%为男性，平均年龄85.3±5.2岁，平均左心室射血分数60.3±7.6%，平均最大左心室壁厚度17.2[12-25]mm。大多数患者为纽约心脏协会II级（48.4%）或III级（46.8%）。除了比非ATTR-CA患者年龄更大外，ATTR-CA患者NT-proBNP水平中位数更高（3801[2266-7132] vs 2391[1141-4796]pg/mL；P=0.003）。ATTR-CA患病率在性别上无统计学差异（男性为19.7%，女性为13.8%，P=0.085）。约7%（4/56）的患者存在基因变异（ATTRv）。
这项全国多中心研究发现患病率为16.8%，证实ATTR-CA是年龄超过75岁且左心室肥厚的男性和女性HFpEF的重要病因。
