title: Pilot study for left ventricular imaging phenotype of patients over 65 years old with heart failure and preserved ejection fraction: the high prevalence of amyloid cardiomyopathy.
abstract: This study sought to phenotype patients over 65 years old with heart failure and preserved ejection fraction (HFpEF) using clinical available comprehensive cardiovascular imaging modalities. Forty-nine patients with HFpEF and without coronary artery disease underwent clinical evaluation, electrocardiography, echocardiography, cardiac magnetic resonance (CMR) and99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy (99mTc-DPD). The mean population age was 76 ± 8 years. Most of the patients (53 %) were NYHA class II. Mean NT-Pro-NBNP level was 1961 ± 2372 pg/ml. CMR exhibited a hypertrophic cardiomyopathy or infiltrative pattern in 3 (6 %) and 15 (31 %) patients, respectively. In the latter subgroup,99mTc-DPD was suggestive of transthyretin-related cardiac amyloidosis for nine (18 %) patients, while AL amyloidosis was proven in five patients (10 %) by extracardiac (n = 3, 6 %) or endomyocardial (n = 2, 4 %) biopsies-one patient declined tissue biopsy. Compared to patients with unspecified cardiomyopathy (n = 31), patients with amyloid cardiomyopathy (n = 15 or n = 14/proven) had less hypertension, lower systolic blood pressure and higher NT-pro BNP level. Their electrocardiogram showed lowest QRS voltage and longer QRS duration. Left ventricular (LV) pattern was characterized by a more pronounced LV hypertrophy, a smaller ejection fraction and a decrease of global longitudinal strain associated with an increase of longitudinal strain apical-to-basal ratio. In patients over 65 years, HFpEF is a heterogeneous syndrome with at least a 29 % prevalence of amyloid cardiomyopathy. Combined CMR and99mTc-DPD are helpful imaging tools for accurate phenotyping of patients amenable to histopathological diagnosis or genetic testing, and should be considered for proper management of this population. Further longitudinal investigations are needed to better clarify these preliminary results.
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Bennani Smires
authors.affiliation: Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Victor
authors.affiliation: Department of Nephrology and Referral Center for Rare Diseases, University Hospital of Rangueil, Toulouse, France.
authors.forename: David
authors.initials: D
authors.lastname: Ribes
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.|Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Berry
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.|Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.|Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cognet
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.|Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.|Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.|Medical School of Rangueil, University Paul Sabatier, Toulouse, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Méjean
authors.affiliation: Department of Nephrology and Referral Center for Rare Diseases, University Hospital of Rangueil, Toulouse, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Huart
authors.affiliation: Department of Hematology, IUCT Oncopole, Toulouse, France.
authors.forename: Murielle
authors.initials: M
authors.lastname: Roussel
authors.affiliation: Department of Radiology, University Hospital of Rangueil, Toulouse, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Petermann
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.|Medical School of Purpan, University Paul Sabatier, Toulouse, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Roncalli
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.|Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.|Medical School of Purpan, University Paul Sabatier, Toulouse, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.affiliation: Medical School of Rangueil, University Paul Sabatier, Toulouse, France.|Department of Radiology, University Hospital of Rangueil, Toulouse, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Rousseau
authors.affiliation: Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.|Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.|Medical School of Rangueil, University Paul Sabatier, Toulouse, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Berry
authors.affiliation: Department of Nephrology and Referral Center for Rare Diseases, University Hospital of Rangueil, Toulouse, France.|Medical School of Rangueil, University Paul Sabatier, Toulouse, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Chauveau
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.|Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.|Medical School of Rangueil, University Paul Sabatier, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France. lairez@gmail.com.|Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France. lairez@gmail.com.|Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France. lairez@gmail.com.|Medical School of Rangueil, University Paul Sabatier, Toulouse, France. lairez@gmail.com.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lairez
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D003287:Contrast Media / Q000008:administration & dosage; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010641:Phenotype; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals
keywords: Amyloid cardiomyopathy; Cardiac amyloidosis; Cardiac imaging; Heart failure with preserved ejection fraction