Researchers reveal how prealbumin gene alone is insufficient for heart failure diagnosis
Boston, US: Having a genetic variation in the prealbumin gene alone is not adequate for diagnosing transthyretin amyloid cardiomyopathy in older black patients, according to a recent multi-center study headed by researchers at Boston Medical Center and Columbia University.
In a study that was published in the Journal of the American Heart Association, researchers found that a blood test that analyzes the transthyretin or prealbumin protein could be used to diagnose transthyretin amyloid cardiomyopathy and to prompt more thorough imaging examinations.
Researchers found that a blood test that evaluates the transthyretin or prealbumin protein might also be useful in identifying transthyretin amyloid cardiomyopathy and might be utilized to initiate more conclusive imaging testing. Their findings were published in the Journal of the American Heart Association.
Among patients 60 years of age and older, transthyretin amyloid cardiomyopathy (ATTRCM) is a common but underdiagnosed cause of congestive heart failure.
Transthyretin (TTR), also known as prealbumin, is a protein that is related with ATTR-CM and is present in 3.4 per cent of Black people, or 1.5 million people. The predominant genetic variant is V122I (or Val122Ile).
V122I is so prevalent because, when present, it is genetically transmitted 50 per cent of the time from parent to kid. Importantly, it is unclear which individuals with this mutation may eventually develop ATTR.
Researchers note that since more people are getting their genes tested using commercial services, some of which return the V122I test result, it is important for people to know the association between a positive genetic result and the disease with which it is associated.
“Cardiac amyloidosis is a serious heart condition that can be caused by a common genetic variant carried by 1.5 million people,” said senior author Frederick L Ruberg, MD, a cardiologist at Boston Medical Center and Associate Professor of Cardiovascular Medicine and Radiology at Boston University Chobanian & Avedisian School of Medicine.
“Our study shows that of those who have inherited this variant, only 39 per cent developed cardiac amyloidosis, so not everyone who inherits the variant will necessarily develop this serious condition.”
Researchers enrolled 278 self-identified Black heart failure patients from the Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study, funded by the National Institutes of Health.
Study participants live in Boston and New York City and were tested for the genetic variant. Participants were also scanned with a special nuclear heart-imaging test to determine whether they have ATTR-CM.
With 1.5 million people carrying the V122I variant in the US, there are a great number people at risk for ATTR-CM. This study shows that though carriers may have the gene, they will not necessarily develop the disease. The study also shows that just testing for and identifying the V122I variant is not enough to infer that that heart failure is due to cardiac amyloidosis.
“Our study suggests that a widely available blood test to measure prealbumin levels may also be useful in identifying patients that should have more sensitive imaging testing for ATTR-CM,” said co-senior author Mathew Maurer, MD, Arnold and Arlene Goldstein Professor of Cardiology at Columbia University Irving Medical Center and Director of the Cardiac Amyloidosi Program.
“Our results also help better understand how heart failure from ATTR-CM impacts older Black individuals.”
