Introduction: Cardiac amyloidosis (CA) has been considered a rare disease, but different studies show that its prevalence is higher than previously thought. Previous studies carried out on the prevalence of CA are heterogeneous and provide inconclusive and changing data over time that do not allow us to know the real prevalence of this pathology. In Spain, 60% of patients with heart failure (HF) admitted to hospitals are cared for in Internal Medicine Services, and their follow-up is carried out by internists, but there are no prevalence studies in this type of Internal Medicine patients. The PREVAMIC is a study designed by the HF Working Group of the Spanish Society of Internal Medicine to known the Prevalence of CA in HF patients cared by internists. Objectives: The main objective is to estimate the prevalence of different types of CA in patients with HF, aged 65 years and older, with left ventricular hypertrophy, managed in Internal Medicine departments. Secondary objectives are to describe clinical, laboratory, and echocardiographic features of patients with CA and to compare 1-year readmissions and mortality rates in patients with and without CA. Methods: A multicenter, observational, cross-sectional, prospective, cohort study with a 1-year follow-up. Inclusion criteria: Inpatients or outpatients with HF, aged ≥ 65 years, both genders, with septum or posterior wall > 12 mm, under the care of internists. Conclusions: Our prospective investigation study aims to improve knowledge about the prevalence of CA in patients with HF treated in the Internal Medicine setting.

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Background: Cardiac amyloidosis (CA) could be a common cause of heart failure (HF). The objective of the study was to estimate the prevalence of CA in patients with HF. Methods: Observational, prospective, and multicenter study involving 30 Spanish hospitals. A total of 453 patients ≥ 65 years with HF and an interventricular septum or posterior wall thickness > 12 mm were included. All patients underwent a 99mTc-DPD/PYP/HMDP scintigraphy and monoclonal bands were studied, following the current criteria for non-invasive diagnosis. In inconclusive cases, biopsies were performed. Results: The vast majority of CA were diagnosed non-invasively. The prevalence was 20.1%. Most of the CA were transthyretin (ATTR-CM, 84.6%), with a minority of cardiac light-chain amyloidosis (AL-CM, 2.2%). The remaining (13.2%) was untyped. The prevalence was significantly higher in men (60.1% vs 39.9%, p = 0.019). Of the patients with CA, 26.5% had a left ventricular ejection fraction less than 50%. Conclusions: CA was the cause of HF in one out of five patients and should be screened in the elderly with HF and myocardial thickening, regardless of sex and LVEF. Few transthyretin-gene-sequencing studies were performed in older patients. In many patients, it was not possible to determine the amyloid subtype.

En este caso clínico, se muestra la utilidad de los sensores continuos de glucosa, con el fin de descubrir pacientes que por hemoglobina glicosilada están aparentemente bien tratados cuando la realidad es otra completamente diferente: mucha variabilidad, hipoglucemias inadvertidas. El uso de las nuevas insulinas lentas permite controlar mejor la variabilidad de muchos pacientes, al tiempo que disminuye el riesgo de hipoglucemias.

Varón de 55 años con diabetes mellitus tipo 2 de 13 años de evolución y con mal control metabólico que es remitido a las consultas de Medicina Interna para ajuste de tratamiento.