JACC. Advances · 2026
Sex Differences in Presentation and Outcomes of Transthyretin Amyloid Cardiomyopathy.
СтатьяНазвание и аннотация: Перевод в очереди
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Ciocca Nicola, Fuentes Artiles Rubén, Studer Bruengger Annina, Hugelshofer Sarah, Stämpfli Simon F, Ehl Niklas F, Pieczora Lukas, Suter Annatina, Pongan Damiano, Ministrini Stefano, Pfister Otmar, Meyer Philippe, Shiri Isaac, Hunziker Lukas, Hundertmark Moritz J, Gräni Christoph
Аннотация
BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CM) is more often diagnosed in men than in women but sex-specific data remain limited.
OBJECTIVES: The objective of the study was to characterize sex-related differences in presentation and outcomes in patients with ATTR-CM.
METHODS: Consecutive prospective patients with confirmed ATTR-CM enrolled in the multicenter Swiss-CARE registry (February 2018-March 2025) were analyzed. Clinical data were obtained at diagnosis, 6 months postdiagnosis, and yearly thereafter. The primary endpoint was first major adverse cardiac event (MACE) (ie composite of heart failure hospitalization and all-cause mortality). Kaplan-Meier and Cox proportional hazards models were employed.
RESULTS: Among 567 patients with ATTR-CM (age 77 ± 7 years, 52 [9%] women), women were older at diagnosis (80.3 ± 6.1 vs 76.9 ± 6.9 years; P < 0.001), had a higher NYHA functional class (P < 0.001), higher N-terminal pro-B-type natriuretic peptide (2,574 vs 1,632 pg/mL; P = 0.006), and shorter 6-minute walking distance (320 ± 111 vs 411 ± 114 m; P = 0.001). Tafamidis was less frequently prescribed in women (50.0% vs 69.7%; P = 0.004). Women had a higher incidence of MACE (HR: 1.86; 95% CI: 1.13-3.04; P = 0.014), driven by increased heart failure hospitalizations within the first 2 years (HR: 2.21; 95% CI: 1.17-4.19; P = 0.015) and a trend toward higher all-cause mortality (HR: 1.82; 95% CI: 0.97-3.43; P = 0.06). In multivariable analyses, sex was not independently associated with MACE (P = 0.23).
CONCLUSIONS: Women exhibited a higher risk of MACE after diagnosis; however, sex was not an independent predictor of outcomes in multivariable analysis. This disadvantage in women may be partly explained by older age at diagnosis, higher NT-proBNP levels, greater symptom burden, and a higher prevalence of comorbidities, rather than intrinsic sex-specific differences in ATTR-CM progression.
OBJECTIVES: The objective of the study was to characterize sex-related differences in presentation and outcomes in patients with ATTR-CM.
METHODS: Consecutive prospective patients with confirmed ATTR-CM enrolled in the multicenter Swiss-CARE registry (February 2018-March 2025) were analyzed. Clinical data were obtained at diagnosis, 6 months postdiagnosis, and yearly thereafter. The primary endpoint was first major adverse cardiac event (MACE) (ie composite of heart failure hospitalization and all-cause mortality). Kaplan-Meier and Cox proportional hazards models were employed.
RESULTS: Among 567 patients with ATTR-CM (age 77 ± 7 years, 52 [9%] women), women were older at diagnosis (80.3 ± 6.1 vs 76.9 ± 6.9 years; P < 0.001), had a higher NYHA functional class (P < 0.001), higher N-terminal pro-B-type natriuretic peptide (2,574 vs 1,632 pg/mL; P = 0.006), and shorter 6-minute walking distance (320 ± 111 vs 411 ± 114 m; P = 0.001). Tafamidis was less frequently prescribed in women (50.0% vs 69.7%; P = 0.004). Women had a higher incidence of MACE (HR: 1.86; 95% CI: 1.13-3.04; P = 0.014), driven by increased heart failure hospitalizations within the first 2 years (HR: 2.21; 95% CI: 1.17-4.19; P = 0.015) and a trend toward higher all-cause mortality (HR: 1.82; 95% CI: 0.97-3.43; P = 0.06). In multivariable analyses, sex was not independently associated with MACE (P = 0.23).
CONCLUSIONS: Women exhibited a higher risk of MACE after diagnosis; however, sex was not an independent predictor of outcomes in multivariable analysis. This disadvantage in women may be partly explained by older age at diagnosis, higher NT-proBNP levels, greater symptom burden, and a higher prevalence of comorbidities, rather than intrinsic sex-specific differences in ATTR-CM progression.