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[Cardiac amyloidosis and red flags: natural history and its impact in morbimortality]
Emilio Blanco-López1, Jorge Martínez-Del Río1, Alba López-Calles2
1Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
Insights
Red flags (RFs) are common signs that appear years before cardiac amyloidosis (CA) diagnosis. Identifying these RFs and their burden is crucial for predicting prognosis in CA patients, especially those with transthyretin amyloidosis.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Diagnostics
Background:
- Cardiac amyloidosis (CA) diagnosis is often delayed.
- Red flags (RFs) are manifestations preceding CA diagnosis.
- Understanding RF chronology and prognostic impact is vital for early detection.
Purpose of the Study:
- To determine the onset timeline of RFs in the natural history of CA.
- To assess the prognostic influence of RFs in CA patients.
- To investigate the association between RF burden and mortality.
Main Methods:
- Retrospective observational study of 102 CA patients (Feb 2016-Dec 2023).
- Defined and tracked 21 RFs and 3 adverse clinical events.
- Analyzed RF onset chronology and prognostic factors.
Main Results:
- High prevalence of RFs (8.4±2.3) observed.
- Integumentary RFs appeared earliest; cardiac RFs appeared closest to diagnosis.
- 49% 2-year mortality; biomarker RFs and ≥10 RFs correlated with higher mortality.
Conclusions:
- RFs are highly prevalent and precede CA diagnosis significantly.
- RF burden is associated with prognosis in transthyretin amyloidosis (ATTR) patients.
- Early identification of RFs can aid in CA management.
Introduction And Objectives:
Red flags (RF) are typical cardiac and extracardiac manifestations that may precede the definitive diagnosis of cardiac amiloidosis (CA) by several years, playing a pivotal role in the early diagnosis of the disease. The principal aim of the research was to determine the chronology of onset of RF throughout the natural history of CA as well as its prognostic influence.
Patients And Methods:
Observational, retrospective inquiry of consecutive patients with a definitive diagnosis of CA in a terciary hospital centre in Ciudad Real (Spain) between February 2016 and December 2023. We defined 21 RF and 3 adverse clinical events, establishing the date of occurrence of each of them.
Results:
102 patients (81.6±7.7 years; 84,3% males) with a diagnosis of CA (89.2% TTR; 10,8% AL) were included. The prevalence of RF was very high (8.4±2.3). In the natural history, the first to appear were integumentary, with the most specific cardiological ones being the closest to diagnosis. The 2-year mortality was 49%, with biomarker RFs and the presence of ≥10 RFs being associated with higher mortality.
Conclusions:
RFs proved highly prevalent among patients with CA and substantially preceded disease diagnosis. RF burden was associated with prognosis in the follow-up of ATTR patients.
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