Right Ventricular Involvement In Wild-type Transthyretin Cardiac Amyloidosis

• Published in: Journal of cardiac failure Vol. 29; no. 4; p. 701
• Main Authors: Vinnakota, Shravya, Ali, Mays T, Chang, Ian C
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2023
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.10.385

Right ventricular involvement in AL amyloidosis has been demonstrated and is associated with a poor prognosis. However, there is limited data on the prevalence and prognostic role of right ventricular involvement in patients with wild-type transthyretin (ATTRwt) amyloidosis. Right heart structural and functional abnormalities are prevalent in patients with ATTRwt amyloidosis at the time of diagnosis. In this retrospective analysis, 116 patients with confirmed ATTRwt cardiac amyloidosis between 1/1/2018-12/31/2018 from a single center were identified and transthoracic echocardiograms obtained within 90 days of diagnosis were reviewed. Conventional echocardiographic measurements and measurements specific to the right heart, including dimension, thickness, area, fractional area change and free wall global longitudinal strain were analyzed. The cohort was predominantly Caucasian (107, 92.2%) and male (110, 94.8%). Average age at diagnosis was 78.4 (72.8-83.4) years. Patients had preserved EF [54% (43-58)], but reduced global LV longitudinal strain [-11% (-13, -18)]. Right heart structural and functional abnormalities were prevalent, including right ventricular (RV) dilatation (47, 53.4%), increased RV wall thickness (77, 87.5%), reduced RV free wall longitudinal strain (52, 85.2%), increased RV systolic pressure (41, 46.6%), moderate or greater RV dysfunction (36, 38.7%) and right atrial enlargement (82, 94.3%). None of the patients in this cohort had completely normal right heart measurements. S Abnormal right ventricular structures and function are common in ATTRwt amyloidosis. Future dedicated studies with multimodality imaging of the right heart are needed to identify prognostic features that may stratify patients at risk for adverse clinical outcomes.