Prevalence of amyloidosis among older cardiac patients with left ventricular hypertrophy: a cross-sectional single-centre study in Moscow, Russia

Objectives To determine the prevalence and clinical characteristics of transthyretin amyloid cardiomyopathy (ATTR-CM) and light-chain cardiac amyloidosis (AL-CA) among older patients presenting with significant left ventricular hypertrophy (LVH).Design Single-centre observational cross-sectional study.Setting Pirogov City Clinical Hospital No. 1 (Moscow, Russia), from January 2023 to August 2024.Participants 113 patients aged≥65 years with interventricular septal or posterior wall thickness≥14 mm were included. Main exclusion criteria were previously diagnosed infiltrative or hypertrophic cardiomyopathies, severe aortic stenosis and recent myocardial infarction.Procedures Participants underwent 12-lead electrocardiography, echocardiography with global longitudinal strain analysis and technetium-99m pyrophosphate scintigraphy. Immunochemical testing and transthyretin (TTR) gene sequencing were performed according to predefined criteria.Primary and secondary outcome measures The primary outcome was the prevalence of ATTR-CM and AL-CA among older patients with LVH. Secondary outcomes included the frequency of clinical ‘red flags’, imaging findings associated with amyloidosis and correlations between clinical and laboratory markers and instrumental parameters.Results ATTR-CM was confirmed in 18 patients, corresponding to a prevalence of 15.9% (95% CI 10.3% to 23.8%). AL-CA was diagnosed in seven patients (6.2%, 95% CI 3.0% to 12.2%). Among those with ATTR-CM, 4 patients (3.5% of the total cohort; 22% of the ATTR-CM group) carried pathogenic TTR mutations, whereas 14 (12%) had the wild-type form. Five additional patients (4.4%) with grade 2 uptake showed no clinical signs of heart failure, suggesting possible detection of preclinical cardiomyopathy. Higher radiotracer uptake grades (2–3) were significantly associated with greater wall thickness, higher biomarker levels (N-terminal pro-brain natriuretic peptide, troponin I) and worse New York Heart Association class.Conclusions These findings highlight the substantial prevalence of cardiac amyloidosis (22.1%, 95% CI 15.5% to 30.6%) among older patients with LVH. The results emphasise the need for heightened clinical awareness and targeted screening strategies to identify patients at early or asymptomatic stages. Further multicentre studies to refine the understanding of ATTR-CM epidemiology in Russia.