Wild-type amyloid transthyretin (ATTR) may be driving an increase in cardiac amyloidosis (CA) diagnoses, according to a study published Aug. 17 in JACC: CardioOncology. In addition, early recognition of less advanced CA cases may explain decreasing mortality rates.

Oscar Westin, MD, et al., used Danish nationwide registries to assess changes in CA patient characteristics between 1998 and 2017. Patients maintained diagnoses for CA in addition to a diagnosis for heart failure, atrial fibrillation, cardiomyopathy, or pacemaker implantation. The participants were assessed in 5-year periods and included control subjects.

There were 619 CA patients evaluated in the study. The median age increased from 67.4 years old to 72.3 years old, and the incidence of male patients rose from 62.1% to 66.2%. The 2-year mortality rate went from 82.6% to 50.2%, and the mortality rate was significantly higher for CA patients than the control subjects. The overall frequency of CA diagnoses increased from 0.88 to 3.56 for every 100,000 people in the Danish population at 65 years of age or older.

The authors conclude that moving forward, “Future studies on clinical outcomes in CA are needed as novel disease-modifying drugs are approved for use in treatment of both [amyloid light chain amyloidosis] and ATTR-CA, revolutionizing the therapeutic possibilities and further drawing important attention to the disease.”

In a separate viewpoint article, Gautam S. Nayak, MD, FACC, explains that due to the wealth of data, diagnostics and treatment of cardiomyopathy caused by ATTR (ATTR-CM), “it really feels as though we’re on the cusp of an incredible movement in cardiology.” He further explains, “Everyone should feel empowered, no matter where you practice. The converging stories of ATTR-CM and [heart failure with preserved ejection fraction] are just beginning, and from what I can tell, it’s going to be incredible.”

Stay tuned for a special issue dedicated to amyloidosis in the October issue of JACC: CardioOncology.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Cardio-Oncology

Keywords: Prealbumin, Atrial Fibrillation, Stroke Volume, ACC International, Amyloidosis, Cardiomyopathies, Heart Failure, Amyloid, Pacemaker, Artificial

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