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 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 (145% 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. (C) 2020 Elsevier Inc. All rights reserved.