Nutritional status and its impact on transthyretin cardiac amyloidosis: unraveling connection

Abstract Introduction Transthyretin cardiac amyloidosis (ATTR) is an infiltrative disease characterized by the deposit of amyloid fibrils in the myocardium, leading to progressive heart failure and arrhythmias. Advances in non-invasive diagnostic techniques and therapeutic strategies have increased interest in ATTR. However, the impact of nutritional status on disease progression, quality of life and clinical outcomes remains unknown. Purpose To assess the nutritional status of ATTR patients and know the impact between patients receiving nutritional supplementation. Methods In this prospective, observational study, 54 patients with ATTR were stratified according to nutritional assessment. Patients were followed for a period of six months. Clinical characteristics, laboratory biomarkers, treatment regimens, nutritional status, quality of life and clinically significant decompensation were evaluated. Results A total of 54 patients were enrolled, of whom 17 (31.5%) met the Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition at baseline, with five requiring nutritional supplementation. Baseline characteristics are summarized in Table 1. Malnourished patients had a significantly higher prevalence of atrial fibrillation (p = 0.034), lower Kansas City Cardiomyopathy Questionnaire (KCCQ) score (p = 0.002) and reduced functional capacity as evidenced by a shorter 6-minute walk test (6MWT) distance (p = 0.041). Malnourished patients had lower Malnutrition Universal Screening Tool (MUST) scores (p 0.001), higher SARC-F scores (p = 0.015) and reduced anthropometric measures (lower mean body weight, body mass index BMI, and leg circumference). The handgrip strength measured by dynamometry was lower in malnourished patients (p = 0.018). The well-nourished patients showed no significant changes over the follow-up, including functional status (Barthel Index, FRAIL test, 6MWT…), quality of life scores (KCCQ, EQOL) and laboratory biomarkers (TTus, NT-proBNP and Ca 12.5). However, after nutritional intervention, malnourished patients demonstrated a significant improvement in 6MWT distance (p = 0.020), a reduction in FRAIL test (p 0.041) and a reduction in NT-proBNP levels (p = 0.035). Other measures, such as dynamometry, showed a trend toward improvement (p=0.058). A subanalysis regarding nutritional status and specific ATTR treatments was performed (Figure 1). An improvement in malnourished patients, regardless of ATTR treatment at six months was observed with nutritional interventions. Conclusion Malnutrition seems to be a prevalent condition in patients with ATTR. Targeted nutritional interventions in malnourished patients may improve quality of life and clinical outcomes, regardless of specific treatment of ATTR, emphasizing the need for a comprehensive assessment. Larger studies with extended follow-up are warranted to better define their impact.Table 1.Baseline characteristics. Figure 1.FU Clinical Assessment Scales