Systemic embolism in amyloid transthyretin cardiomyopathy.

Abstract

AIMS:

Although systemic embolism is a potential complication in transthyretin amyloid cardiomyopathy (ATTR-CM), data about its incidence and prevalence are scarce. We studied the incidence, prevalence and factors associated with embolic events in ATTR-CM. Additionally, we evaluated embolic events according to the type of oral anticoagulation (OAC) and the performance of the CHA2 DS2 -VASc score in this setting.

METHODS AND RESULTS:

Clinical characteristics, history of atrial fibrillation (AF) and embolic events were retrospectively collected from ATTR-CM patients evaluated at four international amyloid centres. Overall, 1191 ATTR-CM patients (87% men, median age 77.1 years [interquartile range-IQR 71.4-82], 83% ATTRwt) were studied. A total of 162 (13.6%) have had an embolic event before initial evaluation. Over a median follow-up of 19.9 months (IQR 9.9-35.5), 41 additional patients (3.44%) had an embolic event. Incidence rate (per 100 patient-years) was 0 among patients in sinus rhythm with OAC, 1.3 in sinus rhythm without OAC, 1.7 in AF with OAC, and 4.8 in AF without OAC. CHA2 DS2 -VASc did not predict embolic events in patients in sinus rhythm whereas in patients with AF without OAC, only those with a score ≥4 had embolic events. There was no difference in the incidence rate of embolism between patients with AF treated with vitamin K antagonists (VKAs) (n = 322) and those treated with direct oral anticoagulants (DOACs) (n = 239) (p = 0.66).

CONCLUSIONS:

Embolic events were a frequent complication in ATTR-CM. OAC reduced the risk of systemic embolism. Embolic rates did not differ with VKAs and DOACs. The CHA2 DS2 -VASc score did not correlate well with clinical outcome in ATTR-CM and should not be used to assess thromboembolic risk in this population.

• Authors: Silvia Vilches, Marianna Fontana, Esther Gonzalez-Lopez, Lindsey Mitrani, Giulia Saturi, Mary Renju, Jan M Griffin, Angelo Caponetti, Sahana Gnanasampanthan, Jeffeny De Los Santos, Christian Gagliardi, Adrian Rivas, Fernando Dominguez, Simone Longhi, Claudio Rapezzi, Mathew S Maurer, Julian Gillmore, Pablo Garcia-Pavia
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 24 Issue 8 Pg. 1387-1396 (08 2022) ISSN: 1879-0844 [Electronic] England
• PMID: 35650018 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)
• Copyright: © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Chemical References

• Anticoagulants
• Fibrinolytic Agents
• Prealbumin

Topics

• Aged
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (complications, drug therapy, epidemiology)
• Cardiomyopathies (epidemiology, etiology)
• Embolism (chemically induced, etiology)
• Female
• Fibrinolytic Agents (therapeutic use)
• Heart Failure (drug therapy)
• Humans
• Male
• Prealbumin
• Retrospective Studies
• Risk Assessment (methods)
• Risk Factors
• Stroke (epidemiology, etiology)