P206 Do We Need Lower Cut–offs of Left Ventricular Wall Thickness to Suspect Cardiac Transthyretin Amyloidosis in Women?

Abstract

Background Echocardiographic reference values for interventricular septal (IVS) thickness (upper reference limit [URL] 11.2 mm in women vs. 12.4 mm in men), and posterior wall (PW) thickness (URL 11.5 mm vs. 12.3 mm, respectively) exist. According to a European Society of Cardiology position statement, cardiac amyloidosis (CA) should be suspected when left ventricular (LV) wall thickness is ≥12 mm and at least one red flag is present. Given the normal difference between men and women, a same cut–off might cause a diagnostic delay in women. Methods Consecutive patients diagnosed with amyloid transthyretin (ATTR)–CA at 3 centers were evaluated. Results The cohort included 302 patients (Pisa, n=215; Brescia, n=58; Trieste, n=29). Women (n=49, 16%) were older than men (median age 83 years [interquartile range 80–85] vs. 80 years [76–84], p=0.009), but their survival free from all–cause death (p=0.380) or heart failure (HF) hospitalization (p=0.381) did not differ significantly. N–terminal pro–B–type natriuretic peptide values (p=0.897), the proportion of patients with variant ATTR (p=0.369), the prevalence of hypertension (p=0.659), diabetes (p=0.629), or New York Heart Association class III–IV (p=0.613) were not different. LV ejection fraction was 53% (43–60%) in women vs. 50% (43–65%) in men (p=0.066), and tricuspid annular plane systolic excursion was 16 mm (13–20) in women vs. 16 mm (14–19) in men (p=0.674). Even relative wall thickness (RWT) did not differ significantly (0.61 [0.49–0.98] in women vs. 0.69 [0.57–0.87] in men; p=0.448). Conversely, women had lower IVS (15 mm [14–18] vs. 17 mm [15–20]) and PW thickness (13 mm [12–16] vs. 15 mm [13–17]). These differences disappeared when IVS and PW thicknesses were indexed for height (as m), height2,7, or body surface area: IVS, p=0.150, 0.212, 0.325, respectively; PW, p=0.309, 0.107, 0.743, respectively. Conclusions At the time of diagnosis, women with ATTR–CA are older, but their biventricular function, the pattern of LV remodeling, and final outcome did not differ significantly from men, suggesting a similar disease stage. Even indexed IVS or PW thicknesses are similar, while non–indexed measures may point to a less advanced disease and then be misleading. Indexed measures or sex–specific cut–offs (e.g., 11 mm in women vs. 12 mm in men) to suspect CA might be considered.