Abstract 13045: Increased Recognition of Transthyretin Amyloid Cardiomyopathy as a Cause of Heart Failure in Women

Abstract

Introduction: Recognition of transthyretin amyloid cardiomyopathy (ATTR-CM) as a cause of heart failure has increased over the past decade. ATTR-CM, particularly wild type (wtATTR-CM), is considered to mainly affect men. Tafamidis was approved by the FDA for the treatment of ATTR-CM based on the results of the ATTR-ACT trial, which only included 13 women with wtATTR-CM (out of 335). We investigated the proportion of women diagnosed with ATTR-CM over time and compared their presenting characteristics to men. Hypothesis: Improved recognition of ATTR-CM has uncovered a higher prevalence of ATTR-CM in women compared to historical estimates. Methods: We compared the presenting characteristics of women to men diagnosed with ATTR-CM. We also compared the proportions of women with ATTR-CM diagnosed before 2019 with those diagnosed 2019-2022. Subgroup analysis of wtATTR-CM patients was performed as well. Results: Over the study period, 140 consecutive patients (81% wild type, 11.4% women) with ATTR-CM were included. The rate of diagnosis of hereditary ATTR-CM in women did not change from pre 2019 (4/69 or 6%) to 2019-2022 (5/71 or 7%). However, for wtATTR-CM, there were 0 women and 51 men diagnosed prior to 2019 as compared to 7 women (11%) and 62 men from 2019-2022. There were several differences in the presenting characteristics between men and women in the combined ATTR-CM group (Table). However, in the wtATTR-CM group, the only significant differences were higher left ventricular ejection fraction and smaller systolic and diastolic diameters in women (Table). Conclusions: There has been a rapid increase in the rate of diagnosis of wtATTR-CM in women. Ongoing education and a changing diagnostic landscape will redefine wtATTR-CM epidemiology.