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. 2025 Mar 25:58:101658.
doi: 10.1016/j.ijcha.2025.101658. eCollection 2025 Jun.

Incidence and associated factors with atrial fibrillation in patients with transthyretin amyloidosis cardiomyopathy: Insights from the multicenter REACT-SP registry

Cristhian Espinoza Romero  1 , Edileide B Correia  2 , Alzira De Siqueira Carvalho  3 , Ariane Vieira Scarlatelli  4 , Otavio Rizzi Coelho Filho  5 , Phillip Scheinberg  6 , Murillo De Antunes  7 , Pedro Vellosa Schwartzmann  8 , Sandrigo Mangini  9 , Wilson Marques Junior  10 , Marcus Simões  10 , Renato D Lopes  11 , Fabio Fernandes  1
Affiliations

Incidence and associated factors with atrial fibrillation in patients with transthyretin amyloidosis cardiomyopathy: Insights from the multicenter REACT-SP registry

Cristhian Espinoza Romero et al. Int J Cardiol Heart Vasc. .

Abstract

Introduction: Atrial fibrillation (AF) presents a treatment challenge in patients with amyloidosis cardiomyopathy, particularly in transthyretin amyloidosis cardiomyopathy (ATTR-CM). Identifying factors associated with AF is important for early diagnosis and intervention.

Purpose: This study aims to identify factors linked to AF in ATTR-CM patients.

Methods: The REACT registry, a retrospective, multicenter cohort study, enrolled patients with TTR mutation or wild type. ATTR-CM diagnosis was based on echocardiography and pyrophosphate scintigraphy, with some cases confirmed by biopsy. Binary logistic regression and multivariate analysis were used, with ROC curve analysis determining optimal cutoff points for continuous variables.

Results: The study included 273 patients, mostly male (73.2 %), with a median age of 73 years. The ATTR variant was found in 67.3 % (165 patients), and Val142Ile was the most common variant (29.3 %). AF was present in 25.2 % (59 patients). Logistic regression revealed age (per 10-year increase) and left atrial diameter (per 5-mm increase) as predictors of AF, with odds ratios of 1.714 (p = 0.009) and 1.631 (p = 0.002), respectively. ROC curve analysis identified age ≥ 70 years and left atrium > 45 mm as optimal cutoff points (AUC 0.643 and 0.727).

Conclusions: In the ATTR amyloidosis registry, older age and increased left atrium size are associated with AF. These findings may help in the early diagnosis and management of AF in ATTR-CM patients.

Keywords: Amyloidosis; Atrial fibrillation; Thromboembolism; Transthyretin.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Main findings of factors associated with atrial fibrillation in patients with ATTR-CM.
Fig. 1
Fig. 1
Flow chart of the included population.
Fig. 2
Fig. 2
ROC curve of AF predictors / Left atrium (left) and Age (right).
See this image and copyright information in PMC

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