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Pilot study for left ventricular imaging phenotype of patients over 65 years old with heart failure and preserved ejection fraction: the high prevalence of amyloid cardiomyopathy

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Abstract

This study sought to phenotype patients over 65 years old with heart failure and preserved ejection fraction (HFpEF) using clinical available comprehensive cardiovascular imaging modalities. Forty-nine patients with HFpEF and without coronary artery disease underwent clinical evaluation, electrocardiography, echocardiography, cardiac magnetic resonance (CMR) and 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy (99mTc-DPD). The mean population age was 76 ± 8 years. Most of the patients (53 %) were NYHA class II. Mean NT-Pro-NBNP level was 1961 ± 2372 pg/ml. CMR exhibited a hypertrophic cardiomyopathy or infiltrative pattern in 3 (6 %) and 15 (31 %) patients, respectively. In the latter subgroup, 99mTc-DPD was suggestive of transthyretin-related cardiac amyloidosis for nine (18 %) patients, while AL amyloidosis was proven in five patients (10 %) by extracardiac (n = 3, 6 %) or endomyocardial (n = 2, 4 %) biopsies—one patient declined tissue biopsy. Compared to patients with unspecified cardiomyopathy (n = 31), patients with amyloid cardiomyopathy (n = 15 or n = 14/proven) had less hypertension, lower systolic blood pressure and higher NT-pro BNP level. Their electrocardiogram showed lowest QRS voltage and longer QRS duration. Left ventricular (LV) pattern was characterized by a more pronounced LV hypertrophy, a smaller ejection fraction and a decrease of global longitudinal strain associated with an increase of longitudinal strain apical-to-basal ratio. In patients over 65 years, HFpEF is a heterogeneous syndrome with at least a 29 % prevalence of amyloid cardiomyopathy. Combined CMR and 99mTc-DPD are helpful imaging tools for accurate phenotyping of patients amenable to histopathological diagnosis or genetic testing, and should be considered for proper management of this population. Further longitudinal investigations are needed to better clarify these preliminary results.

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Abbreviations

99mTc-DPD:

99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy

CMR:

Cardiac magnetic resonance

DCE:

Delayed contrast enhancement

eGFR:

Estimated glomerular filtration rate

HCM:

Hypertrophic cardiomyopathy

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

mTTR:

Muted transthyretin related

wtTTR:

Wild-type transthyretin-related

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Authors and Affiliations

  1. Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France

    Youssef Bennani Smires, Matthieu Berry, Thomas Cognet, Simon Méjean, Jérôme Roncalli, Didier Carrié, Michel Galinier & Olivier Lairez

  2. Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France

    Gérard Victor, Thomas Cognet, Simon Méjean, Isabelle Berry & Olivier Lairez

  3. Department of Nephrology and Referral Center for Rare Diseases, University Hospital of Rangueil, Toulouse, France

    David Ribes, Antoine Huart & Dominique Chauveau

  4. Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France

    Matthieu Berry, Thomas Cognet, Simon Méjean, Didier Carrié, Isabelle Berry, Michel Galinier & Olivier Lairez

  5. Medical School of Rangueil, University Paul Sabatier, Toulouse, France

    Simon Méjean, Hervé Rousseau, Isabelle Berry, Dominique Chauveau, Michel Galinier & Olivier Lairez

  6. Department of Hematology, IUCT Oncopole, Toulouse, France

    Murielle Roussel

  7. Department of Radiology, University Hospital of Rangueil, Toulouse, France

    Antoine Petermann & Hervé Rousseau

  8. Medical School of Purpan, University Paul Sabatier, Toulouse, France

    Jérôme Roncalli & Didier Carrié

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  1. Youssef Bennani Smires
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  2. Gérard Victor
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Correspondence to Olivier Lairez.

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Bennani Smires, Y., Victor, G., Ribes, D. et al. Pilot study for left ventricular imaging phenotype of patients over 65 years old with heart failure and preserved ejection fraction: the high prevalence of amyloid cardiomyopathy. Int J Cardiovasc Imaging 32, 1403–1413 (2016). https://doi.org/10.1007/s10554-016-0915-z

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  • DOI: https://doi.org/10.1007/s10554-016-0915-z

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