Comparison of Patterns of Coronary Artery Disease in Patients with Heart Failure by Cardiac Amyloidosis Status

Background/purpose: The aim of this study is to characterize the pattern and the severity of coronary artery lesions in cardiac amyloidosis.

Methods: We retrospectively compared patients with heart failure who were tested positive (i.e., biopsy or gene tests – HF/CA+) against those who tested negative (HF/CA-) for cardiac amyloidosis. Groups were compared demographically and angiographically for qualitative and quantitative variables to determine patterns of involvement in the major epicardial coronary vessels.

Results: The study included 110 heart failure patients, of whom, 55 patients (88 lesions) were in the HF/CA+ group, and 55 patients (66 lesions) were HF/CA-. Despite the advanced age of HF/CA+ patients (74.5 ± 11.0 years vs. 54.1 ± 15.0 years; p = 0.05), no severe calcification was found in the HF/CA+ group (0.0% vs. 4.5%; p = 0.018). The HF/CA+ group also had fewer ostial lesions (3.4% vs. 15.1%; p = 0.0095) and a higher, albeit not significant, Thrombolysis in Myocardial Infarction frame count (30.4 ± 12.6 vs. 26.6 ± 11 frames; p = 0.06). In the HF/CA+ group, men had a significant number of tandem lesions compared to women (14.5% vs 0.0%, p = 0.02).

Conclusions: Overall, heart failure patients with cardiac amyloidosis were older but were found to have less calcified lesions, less ostial involvement, and a reduced anterograde coronary blood flow. This is the first report examining coronary lesions in heart failure patients with cardiac amyloidosis.

Summary: Previous studies have shown the involvement of amyloid in cardiac tissue and vasculature, as various methods to determine the deposition of the protein have been studied. However, the pattern or severity of disease in the coronary vasculature using coronary angiography has not yet been investigated. Patients with heart failure and cardiac amyloidosis had numerous lesions in the coronaries that were less calcified with less ostial involvement and reduced anterograde blood flow compared to amyloid-negative heart failure patients.