Research Associate RIMUHC / CRCHUM Montreal, Canada
Background: Cardiac amyloidosis (CA) has several characteristics, and prognosis is associated with the type of amyloidosis and extent of cardiac involvement. Patients often experience multiple organ involvement, and gastrointestinal symptoms are common in the disease. Evidence indicates that malnutrition is a significant concern among CA patients, though the reported prevalence varies from 25 to 60% across studies due to differing methodologies. The impact of this comorbidity on survival requires further investigation. This study aims to evaluate the nutritional status and examine its relationship with functional capacity, quality of life (QoL), and survival in patients with Cardiac Amyloidosis (AL and ATTR).
METHODS AND RESULTS: This pilot study included 29 patients with either ATTR or AL CA (n=14 AL and n=15 ATTR). Data collection was conducted between January 2020 and May 2025. Nutritional status was assessed at baseline by anthropometry (weight, height, mid-upper arm circumference, and triceps skinfold thickness), body mass index (BMI according to WHO), and Subjective Global Assessment (SGA). Functional capacity was evaluated by Handgrip Strength (HGS) and the 6-minute walk test (6MWT). Quality of Life (QOL) was assessed by SF-36 and KCCQ questionnaires. Survival was recorded approximately 4 years after initial assessment. Groups were compared using the Unpaired T-test, and survival was tested using Kaplan-Meier and Log-Rank (Mantel-Cox). Malnutrition was identified in 62% of patients based on the Subjective Global Assessment (SGA), with no significant difference between types of amyloidosis. Using the conventional Body Mass Index (BMI) evaluation, no malnutrition was detected (0%). Unintentional weight loss (>5%) was recorded in 50% of malnourished patients, compared to 0% among well-nourished individuals. The mean physical score in the SF-36 (p=0.029) and physical limitations score in KQQC (p=0.007) varied with nutritional status in AL patients, but did not show a significant difference for ATTR patients. Overall survival rates were significantly different between nutritional groups (Figure 1. overall analyses; p=0.009), with distinct differences observed for AL type (pannel A; p=0.010), but not for ATTR (pannel B; p=0.251).
Conclusion: Impaired nutritional status appears to have a high prevalence and is associated with reduced quality of life and decreased survival, particularly in AL patients. These results warrant confirmation with a larger sample size. The findings indicate that nutritional status should be incorporated into the routine clinical assessment for these patients. Additionally, a standardized methodological approach should be discussed to facilitate widespread implementation.
