Targeted Screening for Transthyretin Amyloid Cardiomyopathy in Patients With Atrial Fibrillation

Prasad, Pooja; Howell, Stacey J.; Sanghai, Saket; Stecker, Eric C.; Henrikson, Charles A.; Masri, Ahmad; Nazer, Babak

doi:10.1161/circulationaha.122.060596

Cited by 6 publications

(4 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,12,13 Signals for increasing 10-year risks for AF, HF, and mortality emerged around ages 65, 70, and 75 years, respectively, highlighting that AF may be a more sensitive marker of variant risk than HF. While a 2022 study highlighted low amyloid penetrance among those with AF, 14 this cohort was limited by predominantly White race, in whom the prevalence of this variant is very low 3 and with differing risk factors for AF development. 15 Screening, counseling, and early intervention efforts likely need to occur several years before risks are heightened, considering greater treatment efficacy of novel therapeutics when started earlier in the disease process.…”

Section: Discussionmentioning

confidence: 99%

Age Dependency of Cardiovascular Outcomes With the Amyloidogenic pV142I Transthyretin Variant Among Black Individuals in the US

et al. 2023

View full text Add to dashboard Cite

ImportanceHereditary transthyretin cardiac amyloidosis is an increasingly recognized cause of heart failure (HF) with distinct treatment. The amyloidogenic pV142I (V122I) variant is present in 3% to 4% of Black individuals in the US and increases the risk for atrial fibrillation (AF), HF, and mortality. Since hereditary transthyretin cardiac amyloidosis demonstrates age-dependent anatomic penetrance, evaluation later in life may identify survivors at particularly high risk.ObjectiveTo estimate age-dependent risks for cardiovascular events with the variant.Design, Settings, and ParticipantsThis cohort study analyzed Black participants from the Atherosclerosis Risk in Communities (ARIC) study attending visit 1 (1987-1989) (followed up until 2019; median follow-up, 27.6 years). Data analyses were completed from June 2022 to April 2023.ExposurepV142I carrier status.Main outcomesThe association between the variant and AF, HF hospitalization, mortality, and a composite of HF hospitalization or mortality was modeled by generating 10-year absolute risk differences for each year between ages 53 (the median age at visit 1) and 80 years, adjusting for the first 5 principal components of ancestry and sex. As an example, 5- and 10-year risk differences were specifically estimated for the composite outcome among participants surviving to age 80 years.ResultsAmong 3856 Black participants (including 124 carriers) at visit 1, 2403 (62%) were women, 2140 (56%) had hypertension, and 740 (20%) had diabetes, with no differences between groups. The 10-year absolute risk difference between ages 53 and 80 years increased over time for each outcome. Statistical significance for increased 10-year risk difference emerged near ages 65 years for AF, 70 years for HF hospitalization, and 75 years for mortality. Among participants surviving to age 80 years, carriers had a 20% (95% CI, 2%-37%) and 24% (95% CI, 1%-47%) absolute increased risk for HF hospitalization or death at 5 and 10 years, respectively. Thus, at age 80 years, only 4 carriers would need to be identified to attribute 1 HF hospitalization or death over the following decade to the variant.Conclusions and RelevanceIn this study, age-specific risks were provided for relevant outcomes with the pV142I variant. Despite a relatively benign course during earlier years, Black individuals who carry the pV142I variant surviving into later life may be particularly vulnerable. These data may inform timing for screening, risk counseling to patients, and potential strategies for early targeted therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Age Dependency of Cardiovascular Outcomes With the Amyloidogenic pV142I Transthyretin Variant Among Black Individuals in the US

et al. 2023

View full text Add to dashboard Cite

show abstract

“…We cannot ascertain what the reason is. Lastly, a similar effort was made in patients with atrial fibrillation [ 17 ]. In the first cohort of over 800 patients with atrial fibrillation, 11.9% met the criteria for high-risk features of ATTR, defined as age above 60 and LV wall thickness of 12 mm or above.…”

Section: Discussionmentioning

confidence: 99%

Referral for Cardiac Amyloidosis in Patients Who Underwent Transcatheter Aortic Valve Replacement: Results of the Quality Outcome Project

Lee,

Eichelberger,

Patel

et al. 2023

Cureus

View full text Add to dashboard Cite

Background Transthyretin cardiac amyloidosis (ATTR) is an important comorbidity present in severe aortic stenosis (AS). The purpose of this study was to raise awareness of ATTR in patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS among healthcare providers and patients. Methodology We reviewed 197 consecutive TAVR cases performed from 2019 to 2020. Adapting predefined high-risk features for ATTR based on prior literature, we contacted the patients to discuss our clinical suspicion of ATTR and offered a referral to a cardiac amyloid specialist. Results We identified 125 (69.4%) patients who had high-risk features of ATTR. Of the 105 patients contacted, 44 patients agreed to referral, 46 patients were not able to be contacted after several attempts, and 15 patients declined referral. Of the 44 patients who agreed to the referral, 20 patients completed the evaluation for cardiac amyloidosis, all of whom were negative for transthyretin and light-chain cardiac amyloidosis. Conclusions Our attempt to detect ATTR in prior TAVR patients was unsuccessful two to three years post-TAVR. We believe that early detection of cardiac amyloidosis close to the timing of TAVR is important and the most effective means.

show abstract

“…We cannot ascertain what the reason is. Lastly, a similar effort was done in patients with atrial fibrillation [17]. In the first cohort of over 800 patients with atrial fibrillation, 11.9% met the criteria for high-risk feature of ATTR, defined as age above 60 and LV wall thickness of 12mm or above.…”

Section: Discussionmentioning

confidence: 99%

Referral for Cardiac Amyloidosis in Patients who underwent Transcatheter Aortic Valve Replacement: Result of Quality Outcome Project

Lee,

Eichelberger,

Patel

et al. 2023

Preprint

View full text Add to dashboard Cite

Introduction Transthyretin cardiac amyloidosis (ATTR) is important comorbidity present in 10-15% of severe aortic stenosis (AS). The purpose of this study was to raise awareness of ATTR in patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS among healthcare providers and patients. Methods We reviewed 197 consecutive TAVR cases performed from 2019-2020. Based on the presence of predefined high-risk features for ATTR based on prior literature, we subsequently contacted the patients to discuss our clinical suspicion of ATTR and offered a referral to a cardiac amyloid specialist. Results We have identified 125 patients (69.4%) who had high-risk features of ATTR. Of the 105 patients who we were able to contact, 44 patients agreed to referral, 46 patients were not able to be contacted after several attempts, and 15 patients declined referral. Of the 44 patients who agreed to referral, 20 patients completed the evaluation for cardiac amyloidosis, all of which were negative for transthyretin and light chain cardiac amyloidosis. Conclusion In conclusion, our attempt to detect ATTR in prior TAVR patients was unsuccessful after 2-3 years post-TAVR. We believe that early detection of cardiac amyloidosis close to the timing of TAVR is important and the most effective means.

show abstract

Targeted Screening for Transthyretin Amyloid Cardiomyopathy in Patients With Atrial Fibrillation

Cited by 6 publications

References 5 publications

Age Dependency of Cardiovascular Outcomes With the Amyloidogenic pV142I Transthyretin Variant Among Black Individuals in the US

Age Dependency of Cardiovascular Outcomes With the Amyloidogenic pV142I Transthyretin Variant Among Black Individuals in the US

Referral for Cardiac Amyloidosis in Patients Who Underwent Transcatheter Aortic Valve Replacement: Results of the Quality Outcome Project

Referral for Cardiac Amyloidosis in Patients who underwent Transcatheter Aortic Valve Replacement: Result of Quality Outcome Project

Contact Info

Product

Resources

About