A single-center retrospective study of 282 patients with transthyretin amyloid cardiomyopathy (ATTR-CM) found important differences in disease presentation and outcomes by race and socioeconomic status. Compared with White patients, Black patients were more likely to have prior heart failure hospitalization, NYHA class III symptoms, worse kidney function, lower left ventricular ejection fraction, and more adverse hemodynamic findings at diagnosis. After adjustment, Black patients had greater odds of presenting with National Amyloidosis Centre stage 3 disease and a higher risk of heart failure hospitalization or death over 5 years. Most Black patients in the cohort had the p.Val122Ile variant, however, making it difficult to separate the effects of genotype, race, and other factors.

The findings highlight the potential importance of earlier recognition of ATTR-CM in populations at risk for delayed diagnosis. Black patients living in more socioeconomically deprived areas had particularly poor event-free survival, although associations were attenuated after accounting for disease stage, and the authors describe the results as hypothesis-generating. Because the study was conducted at one center and socioeconomic status was measured at the neighborhood rather than individual level, the findings require confirmation. Still, the study underscores the need to consider both clinical and social factors that may affect timely diagnosis and follow-up and to improve representation of Black patients in ATTR-CM research.

Reference: Shankar B, Yanek L, Jefferson A, et al. Race and socioeconomic status impact diagnosis and clinical outcomes in transthyretin cardiac amyloidosis. JACC CardioOncol. 2024 Jun;6(3):454-463. doi: 10.1016/j.jaccao.2024.05.001. Epub 2024 Jun 18. PMID: 38983379; PMCID: PMC11229544. 

A recent narrative review highlights important sex-associated differences in transthyretin amyloid cardiomyopathy (ATTR-CM) that may contribute to underdiagnosis in women. Women are typically diagnosed later than men and may present with a less overt hypertrophic phenotype. This includes lower absolute ventricular wall thickness and weaker myocardial uptake on technetium-99m pyrophosphate scintigraphy. Because commonly used diagnostic clues have historically reflected a predominantly male ATTR-CM population, relying on absolute wall-thickness thresholds or classic imaging features may make disease recognition more difficult in women.

For nurse practitioners and physician associates, the review reinforces the importance of maintaining suspicion for ATTR-CM in older women with heart failure, particularly heart failure with preserved ejection fraction, even when conventional imaging findings are subtle. Women may have better-preserved left ventricular ejection fraction and less apparent myocardial amyloid burden while still presenting with substantial functional impairment. Additionally, extracardiac clues such as carpal tunnel syndrome may be less specific because they are common in women generally. The authors emphasize multimodality imaging, consideration of body-size-indexed cardiac measurements, and greater awareness of sex-related presentation differences as potential ways to improve earlier recognition.

Reference: Barocelli F, Canu E, Tassoni G, et al. Transthyretin Cardiac Amyloidosis in Women: Underdiagnosis, Sex-Specific Phenotypic Expression and Therapeutic Response. J Clin Med. 2026 Aug 3;15(15):6033. doi: 10.3390/jcm15156033. PMID: 42590136; PMCID: PMC13467367.

A recent review highlights transthyretin amyloid cardiomyopathy (ATTR-CM) as an increasingly recognized, but still underdiagnosed, cause of heart failure, atrial fibrillation, conduction disease, and other cardiac abnormalities in older adults. Potential clues may appear years before overt cardiomyopathy, including bilateral carpal tunnel syndrome, lumbar spinal stenosis, biceps tendon rupture, joint replacement, neuropathy, unexplained increased left ventricular wall thickness, and conduction abnormalities. Diagnosis also has shifted substantially toward noninvasive testing: in patients without evidence of a monoclonal plasma cell disorder, grade 2 or 3 myocardial uptake on bone-avid scintigraphy can establish ATTR-CM without cardiac biopsy.

The practical takeaway is to recognize patterns that may warrant earlier evaluation rather than waiting for advanced heart failure. The review emphasizes that disease-modifying therapies appear to provide greater benefit when started earlier in the disease course, making timely recognition increasingly important. Management also differs from conventional heart failure care: maintaining euvolemia is central, standard heart failure therapies may be poorly tolerated in advanced disease, and atrial fibrillation generally requires anticoagulation regardless of CHA₂DS₂-VASc score because of the heightened thromboembolic risk. With multiple TTR-stabilizing and TTR-silencing therapies now available or under investigation, early identification and appropriate referral are becoming increasingly important parts of ATTR-CM care.

Reference: Zeldin L, Brailovsky Y, Maurer MS. Transthyretin amyloid cardiomyopathy: a rapidly evolving landscape. Annu Rev Med. 2026 Jan;77(1):59-74. doi: 10.1146/annurev-med-050124-030735. PMID: 41592935.