Disparities in diagnosis and outcomes in American patients with transthyretin cardiac amyloidosis

Joyce L Ngouchet Nouhossi; Iva Minga; Teodora Szasz; Vien T Truong; Amber E Johnson; Edward Yang; Srisha Kotlo; Varun Subashchandran; Frank Medina; Karolina M Zareba; Akash Goyal; Orlando P Simonetti; Amit R Patel; Cristiane C Singulane; Jai Singh; Vidya Nadig; Shaimaa Fadl; Cory R Trankle; Nitasha Sarswat; Hena N Patel; Victor Mor-Avi; Bryan Smith; Jeremy A Slivnick

doi:10.1007/s10554-025-03436-4

Disparities in diagnosis and outcomes in American patients with transthyretin cardiac amyloidosis

Int J Cardiovasc Imaging. 2025 Jun 5. doi: 10.1007/s10554-025-03436-4. Online ahead of print.

Authors

Joyce L Ngouchet Nouhossi¹, Iva Minga¹, Teodora Szasz², Vien T Truong³, Amber E Johnson¹, Edward Yang¹, Srisha Kotlo¹, Varun Subashchandran¹, Frank Medina¹, Karolina M Zareba⁴, Akash Goyal⁴, Orlando P Simonetti⁴, Amit R Patel⁵, Cristiane C Singulane⁵, Jai Singh⁶, Vidya Nadig⁷, Shaimaa Fadl⁸, Cory R Trankle⁸, Nitasha Sarswat¹, Hena N Patel¹, Victor Mor-Avi¹, Bryan Smith¹, Jeremy A Slivnick⁹

Affiliations

¹ University of Chicago Medicine, 5758 S. Maryland Ave, MC 9067, Chicago, IL, 60637, USA.
² Philips Healthcare, Cambridge, MA, USA.
³ Nazareth Hospital, Philadelphia, PA, USA.
⁴ The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁵ University of Virginia, Charlottesville, VA, USA.
⁶ Atrium Health, Charlotte, NC, USA.
⁷ Hartford Hospital, Hartford, CT, USA.
⁸ Virginia Commonwealth University, Richmond, VA, USA.
⁹ University of Chicago Medicine, 5758 S. Maryland Ave, MC 9067, Chicago, IL, 60637, USA. jslivnick@bsd.uchicago.edu.

PMID: 40474003
DOI: 10.1007/s10554-025-03436-4

Abstract

Although Afro-Caribbean (AC) race has been associated with worse outcomes in many cardiovascular diseases, its potential association with transthyretin cardiac amyloidosis (ATTR-CA) is less understood. We aimed to assess the relationship between race and serum biomarkers, adverse cardiac remodeling, and outcomes in AC vs white ATTR-CA patients. 114 AC and 117 white patients confirmed ATTR-CA who underwent cardiac magnetic resonance (CMR) exam were identified. The relationship between race and the primary endpoint-defined by all-cause mortality or heart failure hospitalization-was assessed using Cox regression analysis. ATTR disease stage was significantly higher at diagnosis in AC vs white patients (p < 0.0001). Left (p = 0.001) and right ventricular ejection fractions (p = 0.0002) were lower and extracellular volume (58% vs 50%) higher in AC vs white patients. At a median follow up time of 365 (IQR, 97-879) days, 44% of patients had experienced the primary endpoint. AC race was strongly associated with the primary endpoint compared with White patients (HR 2.83, 95% CI 1.92-4.23, p < 0.0001). AC patients were found to be at more advanced disease stages at the time of ATTR-CA diagnosis and experienced poor outcomes more frequently, highlighting the need for targeted strategies to address these health inequities.

Keywords: Cardiac amyloidosis; Cardiac magnetic resonance; Cardiomyopathy; Ethnic disparities; Heart failure.