Abstract Background To explore sex differences in the course and phenotype of wild-type transthyretin cardiac amyloidosis (ATTRwt-CM) and determine sex- and age-related survival and prognostic factors. Methods In a retrospective cohort study conducted at the French Cardiac Amyloidosis Reference Center from January 1st, 2008, to December 31st, 2022, we used multiple regression analyses, supervised clustering, Cox models, and a Kaplan-Meier analysis to compare the characteristics of women and men in age quartiles (Qs). Results We included 1062 patients with ATTRwt-CM (180 women, 16%). The women had a higher median interquartile range left ventricular ejection fraction (LVEF; 52% 45-60 vs. 50 43-58 in men) and a lower interventricular septum thickness. 12% of the women and 4.1% of the men had a septum thickness 12 mm (p=.004). The women in Q1 (age at diagnosis ≤77y) had lower LVEF and global longitudinal strain values and a higher prevalence of a septum 12 mm (15.8%, vs 2.0% in men) than older women and men. The death rate for women was higher in Q1 than in Q2-4. Women had a greater risk of sudden death than men (13.8% vs. 4.6%, respectively; odds ratio 95% confidence interval: 3.24 1.56-6.64; p=.001). Tafamidis treatment was associated with better survival in men (hazard ratio 95% confidence interval = 0.61 0.39-0.95) but not in women. Conclusions Younger women (≤77y) with ATTRwt-CM had a thin left ventricle wall but a high death rate. Decreasing the septum thickness cut-off would increase the frequency of ATTR-CM diagnosis in women.
Zaroui et al. (2025) studied this question.