Connecting the Dots Between Cerebral Ischemic Events and Transthyretin-Mediated Cardiac Amyloidosis in Afro-Caribbean Patients

Results from a recent study showed a high prevalence of cerebral ischemic events in Afro-Caribbean patients with transthyretin-mediated cardiac amyloidosis and shed light on risk factors for ischemic events in amyloidosis.

Previously, a link between transthyretin-mediated cardiac amyloidosis (ATTR-CM) and cerebral ischemic events (CIEs) has been hypothesized but not well-defined. Researchers at the University Hospital of Martinique aimed to define this link through a single-center, retrospective, observational study of 120 Afro-Caribbean patients with ATTR-CM.

Of the 120 patients assessed, 14.2% of patients were determined to have wild-type ATTR-CM. Hereditary ATTR-CM represented a much larger portion of the study population, with 60.8% found to have the ATTR-V22I genotype and 18.3% with the ATTR-I107V genotype (genotype was undetermined for 8 patients). More than half the patients (52.5%) had predominantly cardiac manifestations, whereas 47.5% had mixed cardiac and neuropathic involvement.

Patients were followed from July 2005 to October 2019, and the occurrence of CIEs was investigated for cardioembolic origin. To better characterize the origin of ischemic stroke, the ASCOD classification (A: atherosclerosis; S: small vessel disease; C: cardiac pathology; O: other causes; D: dissection) was used.

Of the 120 patients followed, 30.0% presented with CIEs, including 3 transient ischemic attacks and 33 permanent ischemic strokes. Per ASCOD classification, the source of the CIEs was cardioembolism in 69.4% of patients. Findings indicated that the CHA2DS2-VASc (congestive heart failure; hypertension; age; diabetes; stroke-vascular age; sex) score was higher in patients with CIEs (P = .0005), and a CHA2DS2-VASc score ≥3 was determined to be an independent predictor of CIE risk.

These results reveal a high prevalence of CIEs, particularly of cardioembolic etiology, in this population of Afro-Caribbean patients with ATTR-CM. In addition, the study validates CHA2DS2-VASc scores ≥3 as an independent predictive factor of CIEs in patients with ATTR-CM.


Banydeen R, Signate A, Tran TH, et al. Cerebral ischemic events: an overlooked complication of transthyretin cardiac amyloidosis in Afro-Caribbean patients. Front Neurol. 2022;13:878292.

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