Abstract 17200: Improving the Early Detection of Cardiac Amyloidosis: Experience From a Large Urban Academic Center

Abstract

Introduction: Cardiac amyloidosis (CA) is associated with a poor prognosis and the condition is often overlooked or the diagnosis is delayed by an average of 2 years. With the availability of treatment, identifying patients early in the course of the disease could significantly improve outcomes associated with CA. We describe the characteristics of patients with suspected CA and factors associated with obtaining a 99m Technetium-pyrophosphate ( 99m Tc-PYP) scan. Methods: We systematically reviewed and abstracted data from electronic medical records of 199 patients at the Grady Memorial Hospital in Atlanta, Georgia, between January 2018 to October 2019. Eligible patients had an echocardiographic left ventricular posterior wall (LVPWd) or interventricular septal wall (IVSd) thickness in diastole ≥ 1.4 cm and no evidence of aortic stenosis. Descriptive analyses were performed using SAS 9.4. Results: Mean age of sample was 65 ± 13 years (96% blacks, 40% women). Over 72% had health insurance, 87% had an LV ejection fraction > 50%, 52% had a diagnosis of heart failure (HF), and 31% had associated peripheral neuropathy. Fifty-nine (30%) patients had a 99m Tc-PYP scan, 10 had a cardiac MRI and only 1 had an endomyocardial biopsy. Of the 4 patients with confirmed CA, mean age was 79 ± 5 years, mean IVSd was 1.7 ± 02 cm and mean LV mass index was 184 ± 33. All 4 patients were black males, had a 99m Tc-PYP scan and 3/4 had health insurance. Table 1 compares characteristics of patients who received a 99m Tc-PYP scan with those who did not. Overall, age, sex, health insurance status, presence of HF and LVH were not associated with the odds of obtaining a 99m Tc-PYP scan. Conclusion: These preliminary results appear to demonstrate variability in diagnostic testing for CA among patients with similar demographic and bioclinical profiles. Understanding the reasons for these differences may be key in improving early testing and diagnosis of CA among our patient population.