Abstract 10709: Findings on Cardiology Screening Parameters for Cardiac Amyloidosis Differ Between African American and Non-African American Patients

Abstract

Introduction: Prior studies have shown worse outcomes for African American (AA) patients with cardiac amyloidosis as compared to Caucasians. A potential contribution of diagnostic bias to delayed diagnosis of cardiac amyloidosis in AAs has not previously been explored. Hypothesis: Standard screening parameters for cardiac amyloidosis have worse diagnostic accuracy in AA as compared to non-AA patients. Methods: Patients evaluated at our institution from 2000-2018 for suspected cardiac amyloidosis with diagnostic confirmation by cardiac biopsy were included. Demographic, clinical and laboratory parameters at the time of evaluation were obtained, and ECGs and echocardiograms were analyzed by study personnel. Each parameter was compared between the biopsy positive and biopsy negative groups separately for AA and non-AA patients. Results: Among 223 patients with suspected cardiac amyloidosis, 90 were AA (64% biopsy positive) and 133 were non-AA (51% biopsy positive). Older age, low limb lead voltage, increased relative wall thickness, and apical sparing of longitudinal strain were associated with a positive biopsy in both AAs and non-AAs. Male gender, pseudoinfarct pattern, higher E/e’, and lower voltage-to-mass ratio were associated with a positive biopsy in non-AAs (p<0.05), but not in AAs. This is displayed in the figure below. Brain natriuretic peptide level and left ventricular mass index were higher in the biopsy positive patients among non-AAs, and lower in the biopsy positive patients among AAs. Conclusions: Several traditional screening parameters for cardiac amyloidosis were not discerning for the diagnosis among AAs who underwent cardiac biopsy for evaluation. The development of cardiac amyloidosis screening tools tailored to AA patients may improve clinical outcomes for AAs with cardiac amyloidosis.