Primary Data on ATTR-Amyloidosis Prevalence Among Elderly Patients With Left Ventricular Hypertrophy in Russia.

AIM: To estimate the prevalence of amyloid cardiomyopathy (CM) caused by transthyretin amyloidosis (ATTR) and immunoglobulin light chain (AL) amyloidosis among patients aged >65 years with interventricular septal (IVS) hypertrophy of ≥14 mm. MATERIAL AND METHODS: From January through August 2023, 60 patients (mean age 7.2±7.3 years, 34 (56.67%) men) were enrolled. Patients meeting the inclusion criteria underwent an echocardiographic study with determining the myocardial longitudinal strain, myocardial scintigraphy with 99mTc-pyrfotech, myocardial single-photon emission computed tomography, measurement of N-terminal fragment of brain natriuretic peptide and troponin I, and the immunochemical study of serum and urine proteins with measurement of free light chains. In the presence of grades 2 and 3 radiopharmaceutical uptake according to scintigraphy, a molecular genetic study was performed for differential diagnosis of wild-type transthyretin amyloidosis (wtATTR) and hereditary/variant (hATTR) ATTR-CM. RESULTS: According to data of myocardial scintigraphy with 99mTc-pyrfotech, grade 3 uptake in the absence of monoclonal secretion was detected in 5 (8.3%) cases and grade 2 radiotracer uptake in the absence of monoclonal secretion was detected in 6 (10%) patients. Myeloma complicated by AL amyloidosis and primary AL amyloidosis were found in 5 (8.3%) patients. CONCLUSION: Among patients aged ≥65 years with IVS hypertrophy ≥14 mm, amyloid CM was detected in 20% of cases (12 patients), including 5 cases (8.3%) of AL amyloidosis and 7 cases (11.7%) of ATTR amyloidosis.

[The prognostic value of the method for determining the estimated glomerular filtration rate in chronic heart failure with a preserved left ventricular ejection fraction: focus on cystatin C].

The aim of the present study is to determine the prognostic value of GFR reduction according to the CKD-EPI formula, taking into account blood creatinine and a formula that simultaneously takes into account creatinine and cystatin C in patients who were hospitalized for the first time due to decompensation of chronic heart failure with a preserved left ventricular ejection fraction (HFSA) observation within 24 months. MATERIALS AND METHODS: The study included 117 patients (women - 65.8%, mean age 71.6 ± 9.1 years) hospitalized due to debugging of CHF and having a preserved left ventricular ejection fraction according to echocardiography. The study was a prospective observation for 2 years after the inclusion of each patient. On the first day of hospitalization, all serum samples were taken to determine the level of cystatin C. The estimated glomerular filtration rate (eGFR) was determined using the CKD-EPI formula, taking into account blood creatinine and the combined formula, including creatinine and cystatin C. The combination was used as an end point death and re-hospitalization within two years of follow-up. To determine the effect of a decrease in eGFR on the forecast, the Kaplan-Maer method and the log-rank test were used. Differences were considered statistically significant at p<0.05. The study was approved by the local ethics committee. RESULTS: During the observation period, the mortality rate was almost 12%. At the same time, every third patient was repeatedly hospitalized within two years. In order to determine the effect of reducing GFR on reaching the end points, all patients were divided into groups with eGFR values of more or less than 45 ml/min/1.73 sq.m according to both formulas. When separating patients using the CKD-EPI formula, which includes only creatinine, the groups did not differ in terms of the frequency of reaching the combined end point, as well as its components: death and re-hospitalization. However, patients with eGFR values less than 45 ml/min/1.73 sq. M according to the combined formula data significantly more often reached the combined end point, mainly due to an increase in mortality. CONCLUSION: The data obtained suggest that adding cystatin C to the CKD-EPI formula and appropriately identifying patients with reduced eGFR has a high prognostic value for stratifying the risk of an unfavorable outcome after the first decompensation of HFSSFV.

[Prognostic value of biomarkers in chronic heart failure with preserved left ventricular ejection fraction]. / Prognosticheskoe znachenie biomarkerov pri khronicheskoi serdechnoi nedostatochnosti s sokhranennoi fraktsiei vybrosa levogo zheludochka.

The paper reviews major biomarkers for determining the prognosis in patients with chronic heart failure and preserved ejection fraction. It also considers cystatin C, one of the novel and probably the most practically important biomarkers.