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Prevalence of Orthopedic Manifestations in Patients With Cardiac Amyloidosis With a Focus on Shoulder Pathologies

Alyssa Basdavanos1, Mathew S Maurer2, Lauren Ives1

  • 1Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.

The American Journal of Cardiology
|December 25, 2022
PubMed

Insights

Transthyretin cardiac amyloidosis (ATTR-CA) patients show higher rates of shoulder pathologies than other cardiac amyloidosis types. Early orthopedic manifestations may aid in earlier ATTR-CA diagnosis and treatment.

Area of Science:

  • Cardiology
  • Orthopedics
  • Genetics

Background:

  • Transthyretin cardiac amyloidosis (ATTR-CA) is a restrictive cardiomyopathy.
  • ATTR-CA is linked to orthopedic issues preceding cardiac symptoms.
  • Prevalence of shoulder pathologies in cardiac amyloidosis (CA) is understudied.

Purpose of the Study:

  • To investigate the prevalence of shoulder pathologies in patients with CA.
  • To compare orthopedic manifestations between ATTR-CA and light-chain CA (AL-CA).
  • To assess if orthopedic issues can aid in early CA identification.

Main Methods:

  • Single-center, retrospective, case-control study.
  • Analyzed 1,310 patients with CA (830 ATTR-CA, 480 AL-CA).
  • Compared CA patients to age-matched general population data for arthroplasty odds.

Main Results:

  • ATTR-CA patients had significantly more shoulder pathologies and orthopedic manifestations than AL-CA patients (p <0.001).
  • Patients aged 60+ with ATTR-CA had 6.05x higher odds of shoulder arthroplasty vs. controls.
  • Patients aged 60+ with AL-CA had 1.63x higher odds of shoulder arthroplasty vs. controls.

Conclusions:

  • Shoulder and other orthopedic pathologies are common in ATTR-CA.
  • These findings may facilitate earlier identification of CA patients.
  • Earlier diagnosis can lead to timely intervention and treatment.

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