Clinical, Imaging, and Disease Progression Sex-related Differences in Transthyretin Cardiac Amyloidosis

pp. 120-126

Abstract

Background: Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly diagnosed disease. Sex-related differences in clinical presentation and disease progression have been described; however, we lack local data identifying these differences.
Objective: The aim of this study was to describe sex-related differences in clinical presentation, imaging characteristics at diagnosis, and disease progression in patients diagnosed with ATTR-CA.

Methods: A retrospective, multicenter (two centers) cohort study was conducted including patients diagnosed with ATTR-CA between 2010 and 2025. Clinical, electrocardiographic, and imaging variables at the time of diagnosis, as well as events during follow-up, were obtained from institutional electronic medical records. Baseline characteristics were compared between men and women using appropriate statistical tests. Kaplan-Meier curves were built to estimate the incidence of all-cause mortality, hospitalizations for heart failure, and a composite endpoint of both events.

Results: A total of 186 patients were included: 153 men (82.2%) and 33 women (17.8%). Women were diagnosed at an older age (83 vs. 80 years; p=0.042) and had thinner septal and posterior wall thicknesses (14.8 vs. 16.9 mm; p=0.020 and 12.7 vs. 14.3 mm; p=0.005, respectively) on baseline echocardiography compared with men. On cardiac magnetic resonance imaging (n=108), women had higher left and right ventricular ejection fractions (62% vs. 50%; p=0.031 and 56% vs. 47%; p=0.011, respectively) and lower maximum wall thickness (16.4 mm vs. 18.7 mm; p=0.013). During a median follow-up of 725.5 days (interquartile range, IQR, 342.5–1220), no statistically significant differences in mortality or hospitalizations for heart failure were observed between the two sexes.

Conclusions: In this national cohort of patients with ATTR-CA, women were diagnosed at an older age and had less structural and functional myocardial involvement at the time of diagnosis. However, these differences did not translate into a significant impact on clinical outcomes during follow-up.