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Heart failure, among other cardiovascular problems, is a typical manifestation of transthyretin amyloidosis cardiomyopathy (ATTR-CM). The prevalence of ATTR-CM as a phenotype of heart failure is often underestimated.

Heart failure with preserved ejection fraction (HFpEF) affects more than half of patients with heart failure. The phenotypes of heart failure can vary, and treatment modalities are often targeted with the goal of managing the various comorbidities of HFpEF. Transthyretin amyloidosis cardiomyopathy (ATTR-CM), characterized by the deposition of amyloid fibrils in the heart, may be an underestimated phenotype of HFpEF.

A recent meta-analysis included five retrospective or prospective cohort studies to investigate the prevalence of ATTR-CM in patients with HFpEF. The studies included in the analysis evaluated the prevalence of transthyretin amyloidosis in HFpEF with EF over 40%. A total of 670 patients were included in the analysis, with 74 patients in the ATTR-CM group and 596 patients in the transthyretin-negative group.

Results found that the prevalence of ATTR-CM in patients with HFpEF was 11%. Compared to the transthyretin negative group, patients with ATTR-CM were more likely to be older males and have low voltage criteria on an electrocardiogram. Patients evaluated in the study also had bigger left ventricular mass, a thicker posterior wall, and a thicker septal wall.

Researchers of the study recommend clinicians screen for ATTR-CM in patients with HFpEF due to its high prevalence. Clinicians who understand the clinical characteristics of ATTR-CM may be able to identify ATTR-CM in patients with HFpEF and recommend the appropriate treatment. Tafamidis is an FDA-approved drug that has been shown to reduce mortality and hospitalizations in patients with ATTR-CM. Patients with ATTR-CM and HFpEF could benefit from this medication. However, an appropriate diagnosis of ATTR-CM is necessary.

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Magdi, M., Mostafa, M. R., Abusnina, W., Al-Abdouh, A., Doss, R., Mohamed, S., Ekpo, C. P., Alweis, R., & Baibhav, B. (2022). A systematic review and meta-analysis of the prevalence of transthyretin amyloidosis in heart failure with preserved ejection fraction. American Journal of Cardiovascular Disease, 12(3), 102-111. https://pubmed.ncbi.nlm.nih.gov/35873185/

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