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Impact of iron deficiency on adverse outcomes in transthyretin cardiac amyloidosis
Session:
Sessão de Posters 15 - Prognóstico, estratificação de risco e comorbilidades na amiloidose cardíaca
Speaker:
André Manuel Martins
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
André Manuel Martins; Adriana Vazão; Joana Pereira; Mónica Amado; Carolina Gonçalves; Carolina Esteves; Célia Domingues; Catarina Ruivo; David Durão
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong> Transthyretin cardiac amyloidosis (ATTR-CA) is a restrictive cardiomyopathy associated with symptomatic heart failure (HF) and an increased risk of cardiovascular events. Iron deficiency (ID), a common comorbidity in HF, may also influence outcomes in ATTR-CA, but its prognostic impact remains insufficiently defined.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Objectives:</span></strong><span style="color:black"> This study aimed to assess the prevalence of ID and evaluate its association with clinical outcomes in patients with ATTR-CA </span><span style="color:black">followed at a Cardiomyopathy Clinic in a regional hospital in Portugal.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Methods:</span></strong><span style="color:black"> Retrospective, single-center study including patients diagnosed with ATTR-CA between 2018 and 2024. Baseline clinical and laboratory data were collected (table 1). ID </span><span style="color:black">was defined using</span><span style="color:black"> either the conventional criteria [ferritin <100 µg/L, or 100–300 µg/L with </span><span style="color:black">transferrin saturation (</span><span style="color:black">TSAT) <20%] and the TSAT-based criteria (TSAT <20%). The primary endpoint, a composite of cardiac death and HF hospitalization, was assessed at 18 months. Patients who experienced the primary endpoint (group 1) were compared with those who did not (group 2).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Results:</span></strong> <span style="color:black">61 patients were included (81 ± 6 years, 93% male), of whom 30 (49%) experienced the primary endpoint (group 1). ID was observed in 79% of patients by conventional criteria and in 44% by the TSAT-based criteria, with a higher prevalence in group 1 only under the TSAT-based definition (60 vs 29%, p=0.015). Group 1 patients also had a higher prevalence of atrial fibrillation (AF) (90 vs 52%, p=0.001), chronic kidney disease (CKD) (83 vs 32%, p<0.001) and significant valvular heart disease (33 vs 19%, p<0.001). </span><span style="color:black">In multivariate analysis, AF (OR 8.02, 95% CI 1.53–41.91, p=0.014), CKD (OR 10.63, 95% CI 2.33–48.38, p=0.002) and TSAT <20% (OR 6.29, 95% CI 1.32–19.32, p=0.041) were associated with the occurrence of the primary endpoint. Kaplan-Meier curves showed lower event-free survival in patients with TSAT <20% (Figure 1). Patients with TSAT <20% had higher levels of NT­proBNP at baseline (4870.0 vs. 3810.0 pg/mL, p=0.047). </span>The primary driver of 18-month MACE was HF hospitalizations (60%), followed by <span style="color:black">cardiac death </span>(40%).</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions: </strong>In this cohort of patients with ATTR-CA, ID was highly prevalent, particularly when defined by conventional criteria. However, only the TSAT-based definition demonstrated prognostic relevance, being associated with worse outcomes. These findings highlight the importance of screening for ID, especially TSAT <20%, to identify patients at increased risk.</span></span></span></p>
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