Baseline Characteristics Predict the Presence of Amyloid on Endomyocardial Biopsy
Van-Khue Ton1, Aditya Bhonsale2, Nisha A Gilotra2
1Advanced Heart Failure, Department of Cardiovascular Medicine, University of Maryland Medical Center, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Cardiac amyloidosis (CAm) is common in heart failure (HF) patients with preserved ejection fraction (EF). CAm diagnosis is often delayed, leading to worse survival outcomes.
Area of Science:
- Cardiology
- Cardiovascular Diseases
- Medical Diagnostics
Background:
- Cardiac amyloidosis (CAm) is increasingly recognized in heart failure (HF) patients.
- Underdiagnosis of CAm is common due to low clinical suspicion.
Purpose of the Study:
- To determine the prevalence of CAm in HF patients with preserved ejection fraction (EF).
- To identify predictors of CAm and assess its impact on survival.
Main Methods:
- Retrospective analysis of 259 patients with HF and EF ≥50% who underwent endomyocardial biopsy.
- Multivariable analysis was used to identify independent predictors of CAm.
- Survival analysis was performed over a mean follow-up of 2.6 years.
Main Results:
- Cardiac amyloidosis (CAm) was diagnosed in 73 (28%) of the patients.
- Independent predictors of CAm were identified.
- CAm patients had significantly worse survival (1.5 years) compared to non-CAm patients (6.3 years).
Conclusions:
- Clinicians should suspect CAm in patients with preserved EF (50%-75%), aged over 50, BMI <30 kg/m², peripheral neuropathy, Sokolow-Lyon index ≤15 mm, and septal wall thickness ≥1.4 cm.
- Early suspicion and diagnosis of CAm are crucial for improving patient outcomes.
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.
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