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. 2021 Jul 31;10(15):3415.
doi: 10.3390/jcm10153415.

Frailty in Wild-Type Transthyretin Cardiac Amyloidosis: The Tip of the Iceberg

Amaury Broussier  1   2 , Jean Philippe David  1   3 , Mounira Kharoubi  4 , Silvia Oghina  4 , Lauriane Segaux  1   5 , Emmanuel Teiger  4 , Marie Laurent  1   3 , Isabelle Fromentin  2 , Sylvie Bastuji-Garin  1   5   6 , Thibaud Damy  1   4
Affiliations

Frailty in Wild-Type Transthyretin Cardiac Amyloidosis: The Tip of the Iceberg

Amaury Broussier et al. J Clin Med. .

Abstract

ATTRwt-CA occurs in elderly patients and leads to severe heart failure. The disease mechanism involves cardiac and extracardiac infiltration by amyloid fibrils. The objectives of this study are to describe the frailty phenotype in patients with ATTRwt-CA and to assess the associations between frailty parameters, the severity of cardiac involvement, and the course of amyloid disease. We used multidimensional geriatric tools to prospectively assess frailty in patients with ATTRwt-CA consulting (in 2018-2019) in the French National Reference Center for Cardiac Amyloidosis. We included 36 patients (35 males; median age: 82 years (76-86). A third of the patients were categorized as NYHA class III or IV, and 39% had an LVEF below 45%. The median serum NTproBNP was 3188 (1341-8883) pg/mL. The median duration of amyloidosis was 146 months (73-216). The frequency of frailty was 50% and 33% according to the physical frailty phenotype and the Short Emergency Geriatric Assessment questionnaire, respectively. Frailty affected a large number of domains, namely autonomy (69%), balance (58%), muscle weakness (74%), malnutrition (39%), dysexecutive syndrome (72%), and depression (49%). The severity of CA was significantly associated with many frailty parameters independently of age. Balance disorders and poor mobility were also significantly associated with a longer course of amyloid disease. Frailty is frequent in patients with ATTRwt-CA. Some frailty parameters were significantly associated with a longer course of amyloid disease and CA severity. Taking into account frailty in the assessment and management of ATTRwt should improve patients' quality of life.

Keywords: cardiac amyloidosis; elderly; frailty; geriatric assessment; heart failure; wild-type TTR amyloidosis (ATTRwt).

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Conflict of interest statement

AB has received consultant fees from NOVARTIS and VIFOR. TD has received consultant fees and research support from NOVARTIS, VIFOR, PFIZER, Alnylam, Akcea, and Resmed. The other authors declare that they have no conflicts of interest concerning this article.

Figures

Figure 1
Figure 1
Study flowchart. Consecutive patients with ATTRwt-CA consulting at the French National Reference Center for Cardiac Amyloidosis having agreed to undergo a multidimensional geriatric assessment were prospectively included in the study between April 2018 and June 2019. ATTRwt-CA: wild-type transthyretin cardiac amyloidosis.
Figure 2
Figure 2
Frequency of frailty, and the relationships between frailty and organ impairment in patients with A-TTRwt-CA. The prevalence of frailty among patients with ATTRwt-CA can be explained by the amyloid fibril infiltration of various organs and tissues, particularly the heart, integumentary system, and nerves. FAB: frontal assessment battery, GDS: geriatric depression scale, IADL: instrumental activity of daily living, MNA: mini nutritional assessment, NYHA: New York heart association, SEGA: short emergency geriatric assessment SPPB: short physical performance battery, 7-CDT: 7-clock drawing test.
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