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Endomyocardial Biopsy Characterization of Heart Failure With Preserved Ejection Fraction and Prevalence of Cardiac Amyloidosis.

Authors :
Hahn VS
Yanek LR
Vaishnav J
Ying W
Vaidya D
Lee YZJ
Riley SJ
Subramanya V
Brown EE
Hopkins CD
Ononogbu S
Perzel Mandell K
Halushka MK
Steenbergen C Jr
Rosenberg AZ
Tedford RJ
Judge DP
Shah SJ
Russell SD
Kass DA
Sharma K
Source :
JACC. Heart failure [JACC Heart Fail] 2020 Sep; Vol. 8 (9), pp. 712-724. Date of Electronic Publication: 2020 Jul 08.
Publication Year :
2020

Abstract

Objectives: This study prospectively evaluated endomyocardial biopsies in patients with heart failure with preserved ejection fraction (HFpEF) to identify histopathologic phenotypes and their association with clinical characteristics.<br />Background: Myocardial tissue analysis from a prospectively defined HFpEF cohort reflecting contemporary comorbidities is lacking.<br />Methods: Patients with HFpEF (EF ≥50%) referred to the Johns Hopkins HFpEF Clinic between August 2014 and September 2018 were enrolled for right heart catheterization and endomyocardial biopsy. Clinical features, echocardiography, hemodynamics, and tissue histology were determined and compared with controls (unused donor hearts) and HF with reduced EF (HFrEF).<br />Results: Of the 108 patients enrolled, median age was 66 years (25th to 75th percentile: 57 to 74 years), 61% were women, 57% were African American, 62% had a previous HF hospitalization, median systolic blood pressure was 141 mm Hg (25th to 75th percentile: 125 to 162 mm Hg), body mass index (BMI) was 37 kg/m <superscript>2</superscript> (25th to 75th percentile: 32 to 45 kg/m <superscript>2</superscript> ), and 97% were on a loop diuretic. Myocardial fibrosis and myocyte hypertrophy were often present (93% and 88%, respectively); however, mild in 71% with fibrosis and in 52% with hypertrophy. Monocyte infiltration (CD68+ cells/mm <superscript>2</superscript> ) was greater in patients with HFpEF versus controls (60.4 cells/mm <superscript>2</superscript> [25th to 75th percentile: 36.8 to 97.8] vs. 32.1 cells/mm <superscript>2</superscript> [25th to 75th percentile: 22.3 to 59.2]; p = 0.02) and correlated with age and renal disease. Cardiac amyloidosis (CA) was diagnosed in 15 (14%) patients (HFpEF-CA: 7 patients with wild-type transthyretin amyloidosis [ATTR], 4 patients with hereditary ATTR, 3 patients with light-chain amyloidosis, and 1 patient with AA (secondary) amyloidosis), of which 7 cases were unsuspected. Patients with HFpEF-CA were older, with lower BMI, higher left ventricular mass index, and higher N-terminal pro-B-type natriuretic peptide and troponin I levels.<br />Conclusions: In this large, prospective myocardial tissue analysis of HFpEF, myocardial fibrosis and hypertrophy were common, CD68+ inflammation was increased, and CA prevalence was 14%. Tissue analysis in HFpEF might improve precision therapies by identifying relevant myocardial mechanisms.<br /> (Copyright © 2020. Published by Elsevier Inc.)

Details

Language :
English
ISSN :
2213-1787
Volume :
8
Issue :
9
Database :
MEDLINE
Journal :
JACC. Heart failure
Publication Type :
Academic Journal
Accession number :
32653448
Full Text :
https://doi.org/10.1016/j.jchf.2020.04.007