Impact of Anemia on Mortality and Morbidity in Transthyretin Amyloid Cardiomyopathy

Abstract

Anemia is prevalent in transthyretin amyloid cardiomyopathy (ATTR-CM), but its prognostic significance remains uncertain due to conflicting data mainly in patients not receiving disease-modifying therapy. Additionally, the effect of anemia on morbidity in this population has not been studied. This retrospective study included 270 patients diagnosed with ATTR-CM, receiving disease-modifying treatment (tafamidis), of which 30% (N=80) were anemic (defined as a hemoglobin level <13 g/dL for males and <12 g/dL for females according to the World Health Organization). At baseline, patients with anemia were on average older (mean age 79 vs. 77 years), more likely to be female (21% vs. 12%) and exhibited higher symptom severity based on NYHA class (42% in class III vs. 27%) compared to those without anemia. Additionally, they had a worse Columbia score (mean score 3 vs 5) and Columbia stage (12% in late stage vs. 7.1%) than those without anemia. Kaplan-Meier analysis indicates that anemia was associated with a higher likelihood of mortality, all-cause, and CV hospitalizations (p<0.05). However, in the Cox regression analysis, after adjusting for baseline age, ATTR genotype, and Columbia score, anemia was only associated with a higher risk of all-cause hospitalizations (HR: 1.9 (1.3-2.7), p<0.001) and CV-related hospitalizations (HR: 1.9 (1.2-2.9), p=0.006). In conclusion, this study indicates that anemic patients with ATTR-CM have higher risks of cardiovascular and all-cause hospitalizations compared to non-anemic ATTR-CM patients. Further research is needed to understand how treating anemia may improve outcomes in this high-risk patient population.