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Frailty in Older Patients with Transthyretin Cardiac Amyloidosis
Stéphanie Cazalbou1,2, Louise Naccache3, Sandrine Sourdet3
1Department of Cardiology, University Hospital of Toulouse, 31400 Toulouse, France.
Insights
Most older patients with transthyretin cardiac amyloidosis (ATTR-CA) are frail. Frail patients exhibit more severe symptoms, increased cardiac involvement, and poorer prognosis, necessitating tailored management strategies.
Area of Science:
- Cardiology
- Geriatrics
- Internal Medicine
Background:
- Transthyretin cardiac amyloidosis (ATTR-CA) prevalence rises with age.
- The relationship between frailty and heart failure is increasingly acknowledged.
- Assessing frailty in older ATTR-CA patients is crucial for management.
Purpose of the Study:
- To compare clinical, biological, and echocardiographic features of elderly ATTR-CA patients using the G8 frailty tool.
- To identify differences in disease severity and cardiac involvement based on frailty status.
Main Methods:
- Retrospective study of 52 patients over 75 with confirmed ATTR-CA (Jan 2020 - Apr 2021).
- Evaluated patients via blood tests, transthoracic echocardiography (TTE), and functional assessments (6MWD or CPET).
- Calculated G8 frailty scores to categorize patients.
Main Results:
- 75% of patients were identified as frail by the G8 score.
- Frail patients had more severe NYHA stages (2.2 vs. 1.7, p=0.004) and higher Gilmore stages (62% stage 2/3, p=0.05).
- Frail patients showed reduced global left ventricular strain (-11.7% vs. -14.9%, p=0.014) and thicker interventricular septum (18±2mm vs. 17±2mm, p=0.033).
Conclusions:
- The G8 score identifies a high prevalence of frailty in older ATTR-CA patients.
- Frail patients present with greater symptomatology, cardiac involvement, and worse prognosis.
- Personalized cardiac management strategies are essential for frail ATTR-CA individuals.
Abstract:
Background-Transthyretin cardiac amyloidosis (ATTR-CA) prevalence increases with age. The interplay between frailty and heart failure has been increasingly recognized. The objective of this study is to compare clinical, biological, and transthoracic echocardiography (TTE) characteristics of older ATTR-CA patients according to the G8 frailty screening tool. Methods-Patients over 75 years old with a confirmed diagnosis of ATTR-CA were included between January 2020 and April 2021. All patients underwent a routine blood test, TTE, and a functional assessment with a six-minute walking distance test (6MWD) or cardiopulmonary exercise testing (CPET), and the G8 score was calculated. Results-Fifty-two patients were included. Thirty-nine (75%) patients were frail and their mean NYHA stage was more severe (2.2 vs. 1.7; p = 0.004); 62% of them had a Gilmore stage of 2 or 3 (p = 0.05). Global left ventricular strain (GLS) was lower (-11.7% vs. -14.9%; p = 0.014) and the interventricular septum was thicker (18 ± 2 mm vs. 17 ± 2 mm; p = 0.033) in frail patients. There were no significant differences according to functional tests. Conclusion-The majority of older patients with ATTR-CA are frail according to the G8 score. They are more symptomatic and have an increased cardiac involvement and a poorer prognosis, requiring more personalized cardiac management.
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