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10.1016/j.jacc.2016.03.596

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pmid27386769      J+Am+Coll+Cardiol 2016 ; 68 (2): 161-72
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  • Genotype and Phenotype of Transthyretin Cardiac Amyloidosis in the United States: The Transthyretin Amyloid Outcome Survey (THAOS) #MMPMID27386769
  • Maurer MS; Hanna M; Grogan M; Dispenzieri A; Witteles R; Drachman B; Judge DP; Lenihan DJ; Gottlieb SS; Shah SJ; Steidley DE; Ventura H; Murali S; Silver MA; Jacoby D; Fedson S; Hummel SL; Kristen AV; Damy T; Planté-Bordeneuve V; Coelho T; Mundayat R; Suhr OB; Cruz MW; Rapezzi C
  • J Am Coll Cardiol 2016[Jul]; 68 (2): 161-72 PMID27386769show ga
  • BACKGROUND: Transthyretin amyloidosis (ATTR) is a heterogeneous disorder with multiorgan involvement and a genetic or nongenetic basis. OBJECTIVES: We described ATTR in the United States in the THAOS (Transthyretin Amyloidosis Outcomes Survey) registry. METHODS: Demographic, clinical, and genetic features of patients enrolled in the THAOS registry in the United States (n = 390) were compared to other regions of the world (ROW) (n = 2,140) with a focus on the phenotypic expression and survival in the majority of U.S. subjects with Val122Ile (n = 91) and wild-type ATTR (n = 189). RESULTS: U.S. subjects are older (70 vs. 46 years), more often male (85.4% vs. 50.6%) and more often of African descent (25.4% vs. 0.5%) than ROW. A significantly higher percentage of U.S. patients with ATTR amyloid seen at cardiology sites had wild-type disease than the ROW (50.5% vs. 26.2%). In the United States, 34 different mutations (n = 201) have been reported, with the most common being Val122Ile (n = 91; 45.3%) and Thr60Ala (n = 41; 20.4%). Overall, 91 of 107 patients with Val122Ile (85%) were from the United States, where Val122Ile subjects were younger and more often women and black than wild-type patients, and had similar cardiac phenotype but a greater burden of neurologic symptoms (pain, numbness, tingling, and walking disability) and worse quality of life. Advancing age and lower mean arterial pressure, but not the presence of a TTR mutation, were independently associated with higher mortality from a multivariate analysis of survival. CONCLUSIONS: In the THAOS registry, ATTR in the United States is overwhelmingly a disorder of older adult males with a cardiac-predominant phenotype. Val122Ile is the most common TTR mutation, and neurologic phenotypic expression differs between wild-type disease and Val122Ile, but survival from enrollment in THAOS does not. CLINICAL TRIAL: NCT00628745
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