Afro-Caribbean Heart Failure in the United Kingdom: Cause, Outcomes, and ATTR V122I Cardiac Amyloidosis.
It has been reported that subjects of African descent present with heart failure at a younger age and because of different causes than whites. We present contemporary data from UK Afro-Caribbean patients in London.



All patients with heart failure presenting to St George's Hospital Heart Failure clinic between 2005 and 2012 were included (n=1392). Patients were predominantly white (71%) and male (67%), and median age at presentation was 73 years (range, 18-100 years). In 211 Afro-Caribbean patients, the most common cause of heart failure was nonischemic dilated cardiomyopathy in 27.5% (whites, 19.9%; P<0.001). Lower rates of ischemic cardiomyopathy were observed (13% versus 41%; P<0.001). The fourth most common cause of heart failure in Afro-Caribbeans was cardiac amyloidosis (11.4%). The prevalence may have been even higher as not all patients were tested for amyloidosis. Patients with ATTR V122I had the worst prognosis compared with other causes of Afro-Caribbean heart failure and white patients. To better understand this condition, we analyzed data from the largest international cohort of ATTR V122I patients, followed up at the UK National Amyloidosis Center (n=72). Patients presented with cardiac failure (median age, 75 [range, 59-90] years). Median survival was 2.6 years from diagnosis.



In London, the cause of heart failure varies depending on ethnicity and affects age of presentation and outcomes. In Afro-Caribbean patients, ATTR V122I is an underappreciated cause of heart failure, and cardiomyopathy is often misattributed to hypertension. As promising TTR therapies are in development, increased awareness and proactive detection are needed.
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.). j.dungu@nhs.net.
Jason N
JN
Dungu
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Sofia A
SA
Papadopoulou
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Katharine
K
Wykes
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Ihtisham
I
Mahmood
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Joseph
J
Marshall
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Oswaldo
O
Valencia
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Marianna
M
Fontana
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Carol J
CJ
Whelan
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Julian D
JD
Gillmore
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Philip N
PN
Hawkins
From the Cardiovascular Sciences, St George's University of London, United Kingdom (J.N.D., S.A.P., K.W., I.M., J.M., O.V., L.J.A.); and National Amyloidosis Centre, Royal Free Campus, University College London, United Kingdom (J.N.D., M.F., C.J.W., J.D.G., P.N.H.).
Lisa J
LJ
Anderson
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D028227:Amyloid Neuropathies, Familial / Q000175:diagnosis / Q000208:ethnology* / Q000235:genetics* / Q000401:mortality; D044383:Black People / Q000235:genetics*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000208:ethnology* / Q000235:genetics* / Q000401:mortality; D017691:Caribbean Region / Q000208:ethnology; D004252:DNA Mutational Analysis; D005260:Female; D005787:Gene Frequency; D020022:Genetic Predisposition to Disease; D006333:Heart Failure / Q000175:diagnosis / Q000208:ethnology* / Q000235:genetics* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010641:Phenotype; D011228:Prealbumin / Q000235:genetics*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D044465:White People / Q000235:genetics*; D055815:Young Adult
D011228:Prealbumin
amyloid; blacks; ethnology; heart failure; prognosis