Heart failure with preserved ejection fraction is a heterogeneous clinical syndrome
that includes distinct subtypes with different pathophysiologies, genetics, and treatment.
Distinguishing heart failure with preserved ejection fraction caused by transthyretin
cardiac amyloidosis (ATTR-CA) is critical given its specific treatment. We analyzed
a single-center retrospective cohort to determine the association of body mass index
(BMI) with a composite of either ATTR-CA or the valine-to-isoleucine substitution
(Val122Ile) variant genotype (ATTR-CA+Val122Ile). These BMI differences were prospectively
evaluated in the multicenter Screening for Cardiac Amyloidosis using nuclear imaging
for Minority Populations (SCAN-MP) study of Black and Hispanic patients with heart
failure. The association of BMI with ATTR-CA+Val122Ile was compared by Wilcoxon rank
sum analysis and combined with age, gender, and maximum left ventricle wall thickness
in multivariable logistic regression. In the retrospective analysis (n = 469), ATTR-CA+Val122Ile
was identified in n = 198 (40%), who had a lower median BMI (25.8 kg/m2, interquartile range [IQR] 23.4 to 28.9) than other patients (27.1 kg/m2, IQR 23.9 to 32.0) (p <0.001). In multivariable logistic regression, BMI <30 kg/m2 (odds ratio 2.6, 95% confidence interval 1.5 to 4.5) remained independently associated
with ATTR-CA+Val122Ile with a greater association in Black and Hispanic patients (odds
ratio 5.8, 95% confidence interval 1.7 to 19.6). In SCAN-MP (n = 201), 17 (8%) had
either ATTR-CA (n = 10) or were Val122Ile carriers (n = 7) with negative pyrophosphate
scans. BMI was lower (25.4 kg/m2 [IQR 24.3 to 28.2]) in ATTR-CA+Val122Ile patients than in non-amyloid patients (32.7
kg/m2 [28.3 to 38.6]) (p <0.001), a finding that persisted in multivariable analysis (p = 0.002).
In conclusion, lower BMI is associated with ATTR-CA+Val122Ile in heart failure with
increased left ventricle wall thickness, particularly in Black and Hispanic patients,
and may aid in the identification of those benefiting from ATTR-CA evaluation.
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References
- Characterization of the inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease.Eur J Heart Fail. 2020; 22: 1551-1567
- Identification of transthyretin cardiac amyloidosis using serum retinol-binding Protein 4 and a clinical prediction model.JAMA Cardiol. 2017; 2: 305-313
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Article Info
Publication History
Published online: June 12, 2022
Received in revised form:
April 28,
2022
Received:
March 31,
2022
Footnotes
This work was funded by a National Institute for Health, Bethesda, Maryland, grant R01HL139671. Dr. Maurer receives grant support R01HL139671, R21AG058348, and K24AG036778 from the National Institute for Health, Bethesda, Maryland.
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