Disparities in diagnosis and outcomes in American patients with transthyretin cardiac amyloidosis

Abstract

Although Afro-Caribbean (AC) race has been associated with worse outcomes in many cardiovascular diseases, its potential association with transthyretin cardiac amyloidosis (ATTR-CA) is less understood. We aimed to assess the relationship between race and serum biomarkers, adverse cardiac remodeling, and outcomes in AC vs white ATTR-CA patients. 114 AC and 117 white patients confirmed ATTR-CA who underwent cardiac magnetic resonance (CMR) exam were identified. The relationship between race and the primary endpoint—defined by all-cause mortality or heart failure hospitalization—was assessed using Cox regression analysis. ATTR disease stage was significantly higher at diagnosis in AC vs white patients (p < 0.0001). Left (p = 0.001) and right ventricular ejection fractions (p = 0.0002) were lower and extracellular volume (58% vs 50%) higher in AC vs white patients. At a median follow up time of 365 (IQR, 97–879) days, 44% of patients had experienced the primary endpoint. AC race was strongly associated with the primary endpoint compared with White patients (HR 2.83, 95% CI 1.92–4.23, p < 0.0001). AC patients were found to be at more advanced disease stages at the time of ATTR-CA diagnosis and experienced poor outcomes more frequently, highlighting the need for targeted strategies to address these health inequities.