Frailty in ATTRwt Cardiac Amyloidosis: The hidden part of the iceberg

Abstract

Senile transthyretin amyloidosis (ATTRwt) occurs in elderly patients and leads to severe heart failure (HF). The mechanism of the disease involved cardiac and extra cardiac amyloid fibril infiltrations. Consequence of extracardiac infiltration on frailty has been poorly studied. Ours aims were to describe the frailty phenotype in ATTRwt cardiac amyloidosis (CA) patients, estimate its prevalence, and investigate associations between frailty parameters, and cardiac involvement severity and course of amyloid disease. We prospectively assessed frailty, using multidimensional geriatric tools, in ATTRwt CA patients followed in the French Referral Center for CA, between April 2018 and June 2019. 36 patients (35 males, median age 82 years) with ATTRwt CA were included. One third of patients were in NYHA class III–IV, 39% had a left ventricular ejection fraction < 45%, and NT-proBNP median value was 3188(1341–8883)pg/mL. The median course of the disease was 146 months (73–216). The prevalence of frailty was 50% according to the physical frailty phenotype, and 33% with regard to the SEGA questionnaire. Frailty affected a large number of domains, namely autonomy (69%), balance disorders (58%), muscle weakness (74%), risk of malnutrition (39%), dysexecutive syndrome (72%) and depression (49%) ( Table 1 ). CA severity was significantly associated ( P ≤ 0.05) with numerous frailty parameters independently from age. Furthermore, poor motricity and balance impairment were also significantly associated with a longer course of amyloid disease ( Fig. 1 ). Frailty was highly prevalent in ATTRwt CA patients. Some frailty parameters were significantly associated with a longer course of amyloid disease and CA severity independently from age. Taking in account frailty in ATTRwt assessment and management should improve their quality of life.