• Francesco Cappelli, Giacomo Tini, Domitilla Russo, Michele Emdin, Annamaria Del Franco, Giuseppe Vergaro, Gianluca Di Bella, Anna Mazzeo, Marco Canepa, Massimo Volpe, Federico Perfetto, Camillo Autore, Carlo Di Mario, Claudio Rapezzi, and Maria Beatrice Musumeci.
• Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
• Amyloid. 2021 Mar 1; 28 (1): 12-18.

BackgroundIntracardiac thrombosis is reported to occur frequently in cardiac amyloidosis (CA). However, data regarding arterial thrombo-embolic events (AEs) in CA are limited. We aimed at assessing prevalence, clinical characteristics and predictors of AEs in a large multicentric CA cohort.Methods And ResultsFour-hundred-six consecutive CA patients (134 AL, 73 ATTRm and 199 ATTRwt) from 5 Italian referral centres were retrospectively evaluated and followed-up for a median time of 19 months. Thirty-one patients (7.6%) suffered from an AE, of whom 10 (32.2%) were in sinus rhythm and had no history of AF. There were no significant differences in terms of age, gender and type of CA between patients with or without AEs. Fourteen (7.6%) of 185 patients on anticoagulation had an AE despite therapy. Anticoagulation therapy did not appear to fully protect from the risk of events (HR 1.23, 95%CI 0.52-2.92, p = .64). The only predictor of AEs, in particular among CA patients in sinus rhythm, was a CHA2DS2-VASC score ≥ 3 (HR 2.84, 95%CI 1.02-7.92, p = .05 in overall population; HR 10.13, 95%CI 1.12-91.19, p = .04 in patients in sinus rhythm).ConclusionsIn our large, multicentric, real-world cohort, prevalence and incidence rate of AEs was high. A consistent proportion of events occurred despite anticoagulation therapy or in patients in sinus rhythm. A higher CHA2DS2-VASc score might identify patients at risk of AEs also among those in sinus rhythm.

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