Related Experiment Video
Updated: Jun 24, 2025
A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs
Published on: February 18, 2022
The Most Predictive Red Flags for Suspecting Cardiac Amyloidosis in Patients with Heart Failure with Preserved
Halit Emre Yalvaç1, Selda Murat2, İlknur Ak Sivrikoz3
1Department of Cardiology, Eskişehir City Hospital, Eskişehir, Türkiye.
Insights
Transthyretin cardiac amyloidosis (TTR-CA) affects about 11% of heart failure with preserved ejection fraction (HFpEF) patients. Key red flags like older age and specific ECG patterns strongly predict TTR-CA in HFpEF.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Cardiac amyloidosis (CA) is a myocardial infiltration disease.
- Transthyretin cardiac amyloidosis (TTR-CA) often presents as heart failure with preserved ejection fraction (HFpEF).
- Identifying TTR-CA early in HFpEF patients is crucial for timely management.
Purpose of the Study:
- To identify specific red flag features that increase suspicion for TTR-CA in patients diagnosed with HFpEF.
- To evaluate the diagnostic utility of these red flags in distinguishing TTR-CA from other causes of HFpEF.
Main Methods:
- Prospective study of HFpEF patients assessed for TTR-CA red flag features.
- 167 HFpEF patients underwent Technetium-99m pyrophosphate (99mTc-PYP) cardiac scintigraphy.
- Comparison of red flag features between TTR-CA positive and negative patient groups.
Main Results:
- 11.3% of HFpEF patients were diagnosed with TTR-CA.
- Older age (≥65 years), pseudo infarct patterns, low QRS voltage, and reduced LV-GLS were significant predictors.
- The presence of three or more red flags was associated with a higher likelihood of TTR-CA (P=0.040).
Conclusions:
- TTR-CA is an under-recognized cause of HFpEF, present in about 1 in 10 patients.
- Older age, specific ECG findings (pseudo infarct, low voltage), and reduced LV-GLS are critical indicators for TTR-CA.
- Implementing red flag assessments can improve early detection of TTR-CA in HFpEF populations.
Objective:
Cardiac amyloidosis (CA) is a cardiomyopathy characterized by amyloid infiltration in the myocardium. Transthyretin cardiac amyloidosis (TTR-CA), commonly presenting as heart failure with preserved ejection fraction (HFpEF), was the focus of our study, which aimed to identify red flags that heighten suspicion of CA in HFpEF patients.
Methods:
We prospectively included patients diagnosed with HFpEF. All patients were assessed for TTR-CA red flag features, cardiac and extra-cardiac, as outlined in the 'Diagnosis and Treatment of Cardiac Amyloidosis: A Position Statement of the European Society of Cardiology.' Technetium-99m pyrophosphate (99mTc-PYP) cardiac scintigraphy was performed in 167 HFpEF patients suspected of having TTR-CA. Patients testing positive and negative for TTR-CA were compared based on these red flag features.
Results:
Out of 167 HFpEF patients, 19 (11.3%) were diagnosed with TTR-CA. In the TTR-CA group, 17 (89.5%) patients were 65 years or older. The presence of three or more red flags differentiated the TTR-CA positive and negative groups (P = 0.040). Features such as low voltage and pseudo infarct patterns were more prevalent in the TTR-CA group (P < 0.001 and P < 0.048, respectively). Left ventricular global longitudinal strain (LV-GLS) was lower in the TTR-CA positive group (P < 0.001). Multivariate analysis identified four variables-older age, pseudo infarct pattern, low/decreased QRS voltage, and LV-GLS-as strong, independent predictors of TTR-CA, with significant odds ratios (ORs) of 7.8, 6.8, 16.9, and 1.2, respectively.
Conclusion:
In this study, TTR-CA etiology occurs in approximately one in every ten HFpEF patients. The presence of three or more red flags increases the likelihood of TTR-CA. Older age, pseudo infarct pattern, low/decreased QRS voltage, and reduced LV-GLS are the most significant red flags indicating TTR-CA in HFpEF patients.
Related Concept Videos
01:17Pathophysiology of Heart Failure
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:29Cardiovascular System Abnormal Findings I: Inspection and Palpation
Abnormal findings observed during an inspection