A systematic review and meta-analysis of the prevalence of transthyretin amyloidosis in heart failure with preserved ejection fraction

Department

Internal Medicine

Document Type

Article

Publication Title

American Journal of Cardiovascular Disease

Abstract

Background: Heart failure with preserved ejection fraction is a complex clinical syndrome marked by different phenotypes and related comorbidities. Transthyretin amyloidosis is an underestimated phenotype. We aim to evaluate the prevalence of transthyretin amyloidosis in heart failure with preserved ejection fraction.

Methods: This meta-analysis was conducted according to PRISMA guidelines. A search strategy was designed to utilize PubMed/ Medline, EMBASE, and Google scholar to locate studies whose primary objective was to analyze the prevalence of transthyretin amyloidosis in heart failure preserved ejection fraction.

Results: Of 271 studies initially identified, 5 studies comprising 670 patients were included in the final analysis. The prevalence of transthyretin amyloidosis was 11%. Patients with transthyretin amyloid cardiomyopathy were more likely to be males (RR 1.38; 95% CI 1.09 to 1.75; P< 0.01; I2=37%), and more likely to have low voltage criteria on ECG (RR 2.98; 95% CI 1.03 to 8.58; P=0.04; I2=75%) compared with transthyretin negative group. They also have higher SMD of age (SMD 0.73; 95% CI 0.48 to 0.97; P< 0.01; I2=0%), and NT-proBNP (SMD 0.48; 95% CI 0.02 to 0.93; P=0.04; I2=36%) compared with transthyretin negative group. On reported echocardiogram, they have higher SMD of mass index (SMD 0.77; 95% CI 0.27 to 1.27; P< 0.01; I2=65%), posterior wall thickness (SMD 0.92; 95% CI 0.62 to 1.21; P< 0.01; I2=0%), and septal wall thickness (SMD 1.49; 95% CI 0.65 to 2.32; P< 0.01; I2=87%) compared with transthyretin negative group.

Conclusion: Transthyretin amyloidosis affects 11% of HFpEF patients. Therefore, screening HFpEF patients at risk of cardiac amyloidosis is warranted.

First Page

102

Last Page

111

Volume

12

Issue

3

Publication Date

6-15-2022

Comments

See full list of authors at journal website.

PubMed ID

35873185

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