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Chest pain in cardiac amyloidosis: occurrence, causes and prognostic significance

Laura De Michieli1, Monica De Gaspari2, Giulio Sinigiani1

  • 1Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy.

International Journal of Cardiology
|July 22, 2023
PubMed

Insights

Chest pain is common in cardiac amyloidosis (CA), indicating advanced disease and predicting heart failure hospitalization. Etiologies differ by CA type, with obstructive coronary artery disease (CAD) in ATTR-CA and amyloid involvement in AL-CA.

Area of Science:

  • Cardiology
  • Cardiovascular Diseases
  • Amyloidosis

Background:

  • Chest pain is a known symptom in cardiac amyloidosis (CA).
  • Systematic investigation of chest pain frequency, causes, and significance in CA is lacking.

Purpose of the Study:

  • To investigate the frequency, etiologies, and clinical significance of chest pain in patients with cardiac amyloidosis.
  • To differentiate the causes of chest pain between transthyretin amyloidosis (ATTR-CA) and light chain amyloidosis (AL-CA).

Main Methods:

  • Analysis of clinical, echocardiographic, laboratory, coronary artery imaging, and endomyocardial biopsy (EMB) data from 174 CA patients (104 ATTR-CA, 70 AL-CA).
  • Comparison of characteristics between CA patients with and without chest pain.
  • Assessment of chest pain as a predictor of heart failure hospitalization.

Main Results:

  • Chest pain was reported in 38% of CA patients.
  • Patients with chest pain had higher rates of coronary artery disease (CAD) history, heart failure (HF) symptoms, and elevated cardiac biomarkers (hs-cTnI, BNP).
  • Obstructive CAD was more frequent in ATTR-CA patients with chest pain (53% vs 0% in AL-CA), while vascular/perivascular amyloid deposition was more common in AL-CA patients (80% vs 20% in ATTR-CA).
  • Chest pain predicted future HF hospitalization during follow-up.

Conclusions:

  • Chest pain is a common symptom in CA, reflecting advanced cardiac impairment.
  • Chest pain in CA predicts future heart failure hospitalizations.
  • The underlying causes of chest pain in CA differ between ATTR-CA and AL-CA subtypes.
Abstract

Keywords:
Cardiac amyloidosisCardiac troponinChest painCoronary artery diseaseHeart failureHistology

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