Baseline Characteristics Predict the Presence of Amyloid on Endomyocardial Biopsy

J Card Fail. 2017 Apr;23(4):340-344. doi: 10.1016/j.cardfail.2016.12.006. Epub 2016 Dec 20.

Abstract

Background: Recent studies have suggested a high prevalence of cardiac amyloidosis (CAm) in heart failure (HF) patients. CAm might be underdiagnosed owing to low clinical suspicion.

Methods and results: We performed retrospective analysis of 259 patients with HF and ejection fraction (EF) ≥50% referred for endomyocardial biopsy. Seventy-three (28%) had CAm. Multivariable independent predictors of CAm were identified. Over a mean follow-up of 2.6 ± 3.3 years, CAm patients had worse survival than those without (1.5 y vs 6.3 y; log rank P < .0001).

Conclusions: Clinicians should be suspicious of CAm in patients with EF 50%-75%, >50 years of age, BMI <30 kg/m2, peripheral neuropathy, Sokolow-Lyon index ≤15 mm, and septal wall thickness ≥1.4 cm.

Keywords: Cardiac amyloid; heart failure; predictors.

MeSH terms

  • Aged
  • Amyloid* / analysis
  • Amyloid* / metabolism
  • Amyloidosis / diagnosis*
  • Amyloidosis / pathology
  • Biopsy / methods
  • Electrocardiography / methods
  • Endocardium* / metabolism
  • Endocardium* / pathology
  • Endomyocardial Fibrosis / diagnosis*
  • Endomyocardial Fibrosis / pathology
  • Female
  • Heart Failure* / metabolism
  • Heart Failure* / mortality
  • Heart Failure* / pathology
  • Heart Failure* / physiopathology
  • Humans
  • Male
  • Maryland
  • Middle Aged
  • Myocardium* / metabolism
  • Myocardium* / pathology
  • Prognosis
  • Retrospective Studies
  • Statistics as Topic
  • Stroke Volume

Substances

  • Amyloid