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Review
. 2022 Jun 15;12(3):102-111.
eCollection 2022.

A systematic review and meta-analysis of the prevalence of transthyretin amyloidosis in heart failure with preserved ejection fraction

Mohamed Magdi  1 , Mostafa Reda Mostafa  1 , Waiel Abusnina  2 , Ahmad Al-Abdouh  3 , Ramy Doss  4 , Sarah Mohamed  5 , Chidera Philippa Ekpo  5 , Richard Alweis  1 , Bipul Baibhav  6
Affiliations
Review

A systematic review and meta-analysis of the prevalence of transthyretin amyloidosis in heart failure with preserved ejection fraction

Mohamed Magdi et al. Am J Cardiovasc Dis. .

Abstract

Background: Heart failure with preserved ejection fraction is a complex clinical syndrome marked by different phenotypes and related comorbidities. Transthyretin amyloidosis is an underestimated phenotype. We aim to evaluate the prevalence of transthyretin amyloidosis in heart failure with preserved ejection fraction.

Methods: This meta-analysis was conducted according to PRISMA guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar to locate studies whose primary objective was to analyze the prevalence of transthyretin amyloidosis in heart failure preserved ejection fraction.

Results: Of 271 studies initially identified, 5 studies comprising 670 patients were included in the final analysis. The prevalence of transthyretin amyloidosis was 11%. Patients with transthyretin amyloid cardiomyopathy were more likely to be males (RR 1.38; 95% CI 1.09 to 1.75; P<0.01; I2=37%), and more likely to have low voltage criteria on ECG (RR 2.98; 95% CI 1.03 to 8.58; P=0.04; I2=75%) compared with transthyretin negative group. They also have higher SMD of age (SMD 0.73; 95% CI 0.48 to 0.97; P<0.01; I2=0%), and NT-proBNP (SMD 0.48; 95% CI 0.02 to 0.93; P=0.04; I2=36%) compared with transthyretin negative group. On reported echocardiogram, they have higher SMD of mass index (SMD 0.77; 95% CI 0.27 to 1.27; P<0.01; I2=65%), posterior wall thickness (SMD 0.92; 95% CI 0.62 to 1.21; P<0.01; I2=0%), and septal wall thickness (SMD 1.49; 95% CI 0.65 to 2.32; P<0.01; I2=87%) compared with transthyretin negative group.

Conclusion: Transthyretin amyloidosis affects 11% of HFpEF patients. Therefore, screening HFpEF patients at risk of cardiac amyloidosis is warranted.

Keywords: Transthyretin amyloidosis; cardiac amyloidosis; diastolic heart failure; heart failure; heart failure with preserved ejection fraction; wild-type transthyretin amyloidosis.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flow diagram.
Figure 2
Figure 2
A: Forest plot of being male. B: Forest plot of age. C: Forest plot of diabetes mellitus. D: Forest plot of hypertension. E: Forest plot of coronary artery disease. F: Forest plot of low voltage criteria. G: Forest plot of NT pro-BNP. H: Forest plot of mass index. I: Forest plot of posterior wall thickness. J: Forest plot of septal thickness. K: Forest plot of left ventricular ejection fraction.
See this image and copyright information in PMC

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