[Myocardial amyloid deposition in patients aged over 85 years with heart failure and preserved ejection fraction]

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Y Y Li1, W R Zhu, K Chai

  • 1Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.

Zhonghua Xin Xue Guan Bing Za Zhi
|June 21, 2018
PubMed

Insights

Amyloid deposition is frequent in elderly patients with heart failure with preserved ejection fraction (HFpEF). This suggests a link between myocardial amyloidosis and HFpEF development, independent of myocardial fibrosis.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pathology

Background:

  • Heart failure with preserved ejection fraction (HFpEF) is a growing clinical challenge, particularly in the elderly.
  • The underlying mechanisms of HFpEF remain incompletely understood, with potential contributions from myocardial infiltration diseases.
  • Amyloid deposition in the myocardium is a known cause of heart failure, but its prevalence in elderly HFpEF patients is not well-established.

Purpose of the Study:

  • To investigate the frequency and extent of left ventricular amyloid deposition in elderly patients (≥85 years) diagnosed with HFpEF.
  • To compare amyloid deposition and myocardial fibrosis in HFpEF patients versus age-matched controls.
  • To explore the relationship between myocardial amyloidosis and myocardial fibrosis in this population.

Main Methods:

  • Autopsy database review of 43 patients (28 HFpEF, 15 controls) aged 85-100 years.
  • Histopathological analysis of left ventricular specimens using Congo red and Masson's trichrome staining.
  • Quantitative assessment of amyloid deposition and myocardial fibrosis, with statistical analysis including Kappa test for consistency.

Main Results:

  • Amyloid deposition was significantly more frequent and severe in the HFpEF group (24/28 positive, 7/28 severe) compared to controls (5/15 positive).
  • Moderate to severe myocardial fibrosis was prevalent in both groups (19/28 in HFpEF, 8/15 in controls), but not significantly different.
  • No significant correlation was found between the degree of myocardial amyloidosis and myocardial fibrosis (Kappa=0.2, P=0.820).

Conclusions:

  • Left ventricular amyloid deposition is common in elderly patients with HFpEF.
  • Myocardial amyloidosis may play a significant role in the pathogenesis of HFpEF in this age group.
  • Myocardial amyloidosis and fibrosis appear to be independent pathological processes in elderly HFpEF patients.

Keywords:
AmyloidosisAutopsyCardiac fibrosisHeart failureMyocardium

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