Transthyretin serum levels and clinical outcomes in patients with transthyretin amyloid cardiomyopathy.

Abstract

To study the prognostic value of serum transthyretin levels in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). We analysed the clinical information collected in a prospective registry of consecutive patients with ATTR-CM treated in 7 Spanish hospitals from January 1st, 2018 to October 31st, 2024. Baseline serum transthyretin was correlated by means of multivariable Cox´s regression with long-term clinical outcomes death from any cause and the combined endpoint death from any cause or heart failure (HF) hospitalization. We studied 216 patients with ATTR-CM who were followed over a median period of 835 days. Baseline transthyretin serum levels correlated with older age and with several markers of more advanced cardiac disease, including higher NYHA class and UK-NAC stage, as well as with poorer nutritional status, according to CONUT score. Multivariable Cox´s regression revealed a statistically significant, independent association between increasing values of serum transthyretin and lower risk of death from any cause (adjusted HR per 1 mg/dl = 0.954; 95 % CI 0.921-0.989) and lower risk of the combined endpoint death from any cause or HF hospitalization (adjusted HR per 1 mg/dl = 0.967; 95 % CI 0.936-0.999). Serum transthyretin showed incremental predictive value for both study outcomes in addition to the UK-NAC staging system. Our study suggests that serum transthyretin is an independent prognostic factor in patients with ATTR-CM.