{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:25:13Z","timestamp":1790115913957,"version":"4.0.1"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Aim<\/jats:title>\n<jats:p>Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of heart failure (HF) with preserved left ventricular ejection fraction (LVEF), typically presenting as restrictive cardiomyopathy. The potential co-existence of ATTR-CA with systolic heart failure has not been studied. The aim of this study is to describe the prevalence of ATTR-CA and its clinical characteristics in HF patients with reduced LVEF.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Patients with an unexplained cause of LV systolic dysfunction were screened for ATTR-CA by a <jats:sup>99m<\/jats:sup>Tc-PYP planar scintigraphy. Patients in whom presence of \u2265 2 uptake was confirmed by SPECT imaging were included. Their clinical, laboratory and echocardiographic data were collected.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Out of 75 patients (mean age 65\u00b112 years, LVEF 35.8\u00b17.9%) included in this study, 7 (9.3%) patients (mean age 75\u00b16 years, LVEF 32.0\u00b18.3%) had ATTR-CA. Patients with ATTR-CA were more symptomatic at diagnosis (NYHA FC 3\u20134 (86% vs 35% (p = 0.03)) and had a more severe clinical course evident by recurrent hospitalizations for HF, and a need for intravenous diuretic treatment (p = 0.04 and p&lt;0.01, respectively) at follow-up, compared with patients with no ATTR-CA. Patients with ATTR-CA had similar LVEF but a clear trend for larger LV mass index (157.1\u00b160.6 g\/m<jats:sup>2<\/jats:sup> vs. 121.0\u00b139.5 g\/m<jats:sup>2<\/jats:sup>, p = 0.07) and a larger proportions of ATTR-CA patients had IVS thickness &gt;13 mm (57.1% vs 13.1%, p = 0.02) as compared to HF patients with no ATTR-CA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In our study, a meaningful percentage of patients with unexplained LV dysfunction had a co-existing ATTR-CA indicating that the clinical heterogeneity of ATTR-CA is much broader than previously thought.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0254104","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T18:13:45Z","timestamp":1625854425000},"page":"e0254104","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["Wild-type TTR amyloidosis among patients with unexplained heart failure and systolic LV dysfunction"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5821-1113","authenticated-orcid":true,"given":"Sorel","family":"Goland","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Volodarsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yacov","family":"Fabricant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Livschitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagi","family":"Tshori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeri","family":"Cuciuc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liaz","family":"Zilberman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irena","family":"Fugenfirov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeri","family":"Meledin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Shimoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagie","family":"Josfberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"George","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,7,9]]},"reference":[{"issue":"13","key":"pone.0254104.ref001","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1161\/CIRCULATIONAHA.108.843334","article-title":"Systemic cardiac amyloidoses: disease profiles and clinical courses of the 3 main types","volume":"120","author":"C Rapezzi","year":"2009","journal-title":"Circulation"},{"issue":"10","key":"pone.0254104.ref002","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1161\/CIRCULATIONAHA.111.078915","article-title":"Transthyretin (TTR) cardiac amyloidosis.","volume":"126","author":"FL Ruberg","year":"2012","journal-title":"Circulation"},{"issue":"14","key":"pone.0254104.ref003","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1161\/CIRCULATIONAHA.116.024438","article-title":"Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis","volume":"135","author":"MS Maurer","year":"2017","journal-title":"Circulation"},{"issue":"11","key":"pone.0254104.ref004","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/j.recesp.2017.05.018","article-title":"Diagnosis and Treatment of Transthyretin Cardiac Amyloidosis. 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