Heart failure & cardiomyopathiesCohort study
Clinical Phenotype and Prognosis of Asymptomatic Patients With Transthyretin Cardiac Amyloid Infiltration
- Retrospective cohort study
- multicentre
- 12 international centres
Authors' conclusion
This study shows that asymptomatic ATTR cardiac amyloid infiltration encompasses a wide spectrum of disease severity, with patients with grade 2 or 3 cardiac uptake experiencing an increased rate of CV events and CV mortality and patients with grade 1 uptake experiencing a lower CV event rate and predominantly non-CV mortality.
Study context
- Population
- Asymptomatic patients with ATTR cardiac amyloid infiltration (no heart failure (HF) history, signs or symptoms, diuretic therapy), 12 amyloidosis centres, 2008–2023
- Participants
- 485 patients
- Exposure
- Grade 2 or 3 vs grade 1 cardiac uptake on bone scintigraphy
- Grade 2 or 3n = 369
- Grade 1n = 116reference
- Outcome
- All-cause and CV mortality
- Follow-up
- Median 37 months (IQR, 20-64 months)
Main finding
As reported in the abstract
median follow-up 37 months
Unadjusted hazard ratio
5.30
95% CI 1.92–14.65
Grade 2 or 3 vs Grade 1
unadjusted HR 5.30 (95% CI 1.92–14.65)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Grade 2 or 3 | Grade 1 |
|---|---|---|
| Development of HF · 3 years | 54.3% (95% CI 47.7%–61.3%) | 23.1% (95% CI 14.8%–35.1%) |
| Outpatient diuretic initiation and NT-proBNP progression · 3 years | 35.0% (95% CI 28.0%–43.2%) | 12.4% (95% CI 6.3%–23.7%) |
| HF hospitalization · 3 years | 8.7% (95% CI 5.9%–12.9%) | 0% |
| Unplanned CV hospitalization · 3 years | 20.0% (95% CI 15.7%–25.3%) | 4.3% (95% CI 1.6%–11.3%) |
Original publication
Clinical Phenotype and Prognosis of Asymptomatic Patients With Transthyretin Cardiac Amyloid Infiltration. JAMA Cardiol. Published 1 May 2025. doi:10.1001/jamacardio.2024.5221
Summarised from the published abstract; every number is checked against it