Characteristics and outcomes of Black patients with wild type transthyretin cardiac amyloidosis.

Background: The clinical characteristics and outcomes of Black patients with wild type transthyretin cardiac amyloidosis (ATTRwt-CA) are not well described in the literature.

Methods: We conducted a single center retrospective cohort study of 186 patients with cardiac amyloidosis, of which 62 had ATTRwt-CA, diagnosed at our institution between 2/2010 and 4/2023. We compared clinical, laboratory, electrocardiographic, and echocardiographic characteristics between Black and non-Black ATTRwt-CA patients. Our primary outcome of interest was all cause mortality.

Results: Of the 62 patients with ATTRwt-CA, 19 patients self-identified as Black. Black ATTRwt-CA patients had higher rates of chronic kidney disease (63.2 % vs 23.3 %; p = 0.002), lower glomerular filtration rate (50.8 ± 18.0 vs 63.3 ± 18.4; p = 0.019), and lower rates of carpal tunnel syndrome (36.8 % vs 67.4 %; p = 0.024). There were no significant differences in disease stage (p = 0.058), frequency of NYHA III or IV symptoms (35.3 % vs 35.5 %; p = 0.990), or LVEF (41.2 ± 17.1 vs 49.1 ± 13.2; p = 0.074) at the time of CA diagnosis. Black ATTRwt-CA patients demonstrated higher rates of mortality on both univariate (HR: 5.52; CI 2.05-14.81; p = 0.001) and multivariate (HR: 4.85; CI 1.53-15.41; p = 0.007) Cox regression analysis.

Conclusion: Black patients with ATTRwt-CA demonstrate phenotypic differences and worse survival compared to non-Black patients. The reasons underlying this survival difference warrant further investigation.