Background:
Despite progress in diagnosis and therapy of heart failure (HF),
etiology and risk stratification remain elusive in many patients.
Methods:
The My Biopsy HF Study (German clinical trials register number:
DRKS22178) is a retrospective monocentric study investigating an
all-comer population of patients with unexplained HF based on a thorough
workup including endomyocardial biopsy (EMB).
Results:
655 patients (70.9% men, median age 55 [45/66] years) with
non-ischemic, non-valvular HF were included in the analyses. 489
patients were diagnosed with HF with reduced ejection fraction (HFrEF),
52 patients with HF with mildly reduced ejection fraction (HFmrEF) and
114 patients with HF with preserved ejection fraction (HFpEF). After a
median follow-up of 4.6 (2.5/6.6) years, 94 deaths were enumerated
(HFrEF: 68; HFmrEF: 8; HFpEF: 18), equating to mortality rates of 3.3%
and 11.6% for patients with HFrEF, 7.7% and 15.4% for patients with
HFmrEF and 5.3% and 11.4% for patients with HFpEF after 1 and 5 years,
respectively. In EMB, we detected a variety of putative etiologies of
HF, including incidental cardiac amyloidosis (CA, 5.8%). In multivariate
logistic regression analysis adjusting for age, sex and comorbidities
only CA, age and NYHA functional class III + IV remained independently
associated with all-cause mortality (CA: HRperui 3.13, 95% CI 1.5-6.51; p = 0.002).
Conclusions:
In an all-comer population of patients presenting with HF of
unknown etiology, incidental finding of CA stands out to be
independently associated with all-cause mortality. Our findings suggest
that prospective trials would be helpful to test the added value of a
systematic and holistic work-up of HF of unknown etiology.