{
  "abstract": "Introduction Transthyretin (ATTR) cardiac amyloidosis (CA) is an increasingly recognised cause of left ventricular hypertrophy (LVH) and heart failure (HF). Despite a historically poor prognosis, new therapeutic options create a drive for timely diagnosis.With a growing population of HF in the UK, there is a clinical challenge to identify patients with CA.1 We aimed to phenotype a cohort of patients referred with suspicion of CA, to help clinicians identify who has a high pre-test probability of ATTR CA based on readily available data.Methods Demographic, clinical and imaging data were collected retrospectively through electronic records for patients referred to the Yorkshire Heart Centre (04/2019-10/2020) for 99mTc-DPD scintigraphy (DPD) based on clinical suspicion of CA.Patients were categorised into 2 groups: DPD positive (DPD+) (Perugini 2-3) or DPD negative (DPD-) (Perugini 0-1) and data compared between groups. Light chain CA was excluded in all DPD+ patients.Results Two-hundred and four patients were referred within the search period. Four patients were excluded due to a lack of clinical data, resulting in 200 patients analysed.Patients with ATTR CA were more likely to be older (DPD+ age 80(75,84) vs DPD- 72(59,79)years;P=<0.0001), and more likely to be male (DPD+ female 9(9%) vs DPD- 29(30%);P=0.0002).Type 2 diabetes was less common in DPD+ patients: DPD+ 18(18%) vs DPD- 31(32%). History of unilateral and bilateral carpal tunnel syndrome (CTS) was more common in DPD+ patients (bilateral CTS in DPD+ 24(24%) vs DPD- 7(7%);P=0.0014). There was no significant difference in rates of atrial fibrillation or pacemakers (table 1).DPD+ patients had higher NT-proBNP levels (table 1); 98% of DPD+ patients had an intermediate or high NT-proBNP (n=92), and 84% patients (n=68) in the respective DPD-neg cohort (P=0.0018).Patients with ATTR CA had significantly more LVH on echocardiography compared to DPD- patients: DPD+ IVSd 15(14,18) vs DPD-neg 13(10,16)mm;P=<0.0001), with higher relative wall thickness (table 2). There were higher rates of diastolic dysfunction and higher E/e’ values in DPD+ patients.CMR data were also available (n=130). All DPD+ patients had LVH on CMR, with only 29(52%) of DPD- patients having LVH (P=<0.0001). DPD+ patients also had larger LV masses (table 2). There were no differences in LV systolic function, or left atrial size. T1 values were raised in 96% of DPD+ patients, and 68% of DPD- patients (P=0.0003). ECV was higher in DPD+ patients (table 2). Focal fibrosis was seen in all DPD+ patients, and only 49(86%) of DPD- patients (P=0.0008).Conclusion ATTR CA is one of many causes of LVH in an ageing and increasingly co-morbid population, with finite resource. This work from a regional tertiary care cohort highlights clinical, biochemical and imaging parameters that may prompt clinicians to investigate further for ATTR CA, and thus rationalise investigations and healthcare contact for individuals in this demographic.Abstract 218 Table 1–2",
  "authors": [
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Victoria Palin"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Henry Procter"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Alex Simms"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Kate Gatenby"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Christopher Saunderson"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Andrew Walker"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Fahmid Chowdhury"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Anshu Sengupta"
    }
  ],
  "title": "218 When should cardiac amyloid be suspected in a growing heart failure population?",
  "uid": "9c1a5228-0fdb-5185-a815-28196fbe0245"
}