Abstract 17926: Cardiac Amyloid Deposition is Common in Elderly Patients with Heart Failure and Preserved Ejection Fraction
Introduction: Heart failure (HF) with preserved ejection fraction (HFpEF) is predominantly a disease of the elderly. The pathophysiology of HFpEF is complex with ventricular and vascular dysfunction resulting from age-associated changes, hypertension, diabetes and atherosclerosis. Age related dissociation and misfolding of the carrier protein transthyretin (TTR) leads to deposition of TTR amyloid fibrils in the heart and vasculature (“senile” or wild-type TTR amyloid) which can cause severe diastolic dysfunction. However, the contribution of senile TTR or other types of amyloid to the burden of HFpEF is poorly defined. Importantly, novel proteostatic compounds currently in clinical testing stabilize TTR and may prevent or slow TTR amyloid deposition in the heart.
Objective: To evaluate prevalence of cardiac amyloid deposits in autopsied patients (pts) with HFpEF vs age/sex matched controls.
Methods and Results: Using the Mayo HF Database and the Mayo Autopsy and Tissue Registry, consecutive pts with a HFpEF hospitalization (EF ≥ 45% at HF diagnosis) who had autopsy (n=113) and age/sex matched controls dying of non-cardiovascular causes (n=78); all with consent for research use of autopsy specimens were identified. Formalin fixed paraffin imbedded LV sections were stained with Sulfated Alcian Blue (SAB) and examined by an expert cardiac pathologist blinded to study group. Overall, HFpEF pts (100% Caucasian) had more cardiovascular disease, higher heart weight and more amyloid deposition than controls (table). Of HFpEF pts ≥ age 75 at HF diagnosis (n=63), 20 (32%) had amyloid deposition vs 4 of 50 (8%) pts < 75 at HF diagnosis (p=0.002). Of the 29 pts with amyloid deposition at autopsy, only 6 had a pre-morbid diagnosis of amyloid.
Conclusions: These data suggest that cardiac amyloid deposition is common in elderly HFpEF pts and may contribute to the pathophysiology of HFpEF. Emerging orally active proteostatic compounds offer the potential for specific therapy.
- © 2010 by American Heart Association, Inc.