Prevalence of Cardiac Amyloidosis Among Elderly Patients With Recent-Onset Atrial Fibrillation: The PREVAL-ATTR Study

BACKGROUND: Transthyretin cardiac amyloidosis (ATTR-CA) is increasingly recognized as a treatable form of heart failure. Atrial fibrillation (AF) is common in patients with ATTR-CA. Whether recent-onset AF can be used as an early marker to identify patients with ATTR-CA has not been elucidated. METHODS: This was a prospective study conducted at 3 Spanish centres. ATTR-CA noninvasive screening was offered to patients ≥ 65 years of age recently diagnosed (< 1 year) with nonvalvular AF and who had ≥ 1 echocardiographic, electrocardiographic, or clinical sign suggestive of ATTR-CA. RESULTS: A total of 121 patients were included (75% male, mean age 77 ± 7 years). Ten patients (8.3%; 95% confidence interval CI,4-14.7%), were diagnosed with cardiac amyloidosis (CA): 5 with definite wild-type ATTR-CA (ATTRwt), 4 with likely ATTRwt, and 1 with undetermined CA. Compared with patients without CA, patients with CA were older (84 ± 4 vs 76 ± 7 years; P < 0.001), more frequently men (90% vs 59%; P = 0.047), presented higher median N-terminal pro-B-type natriuretic peptide (NTproBNP) (3800 pg/L, interquartile range IQR:1682-6101 vs 1048 pg/mL, IQR: 427-3154; P = 0.017) and higher left ventricular hypertrophy (LVH) (14 mm, IQR: 13-17 vs 12 mm, IQR: 12-13; P = 0.003). Patients with CA also showed higher rate of permanent AF (90% vs 49.5%; P = 0.018) and a greater need for pacemaker implantation during follow-up (30% vs 7.3%; P = 0.049). No differences in mortality were observed between patients with and without CA after a median follow-up of 13 months (IQR: 11-16 months). CONCLUSIONS: Routine DPD scanning in elderly patients with recent-onset AF, LVH and an additional red flag may help to identify patients with ATTR-CA. However, larger studies evaluating this strategy in more diverse clinical settings would be required.