Men and women differ with regard to the prevalence, phenotype, and prognosis of wild-type transthyretin amyloid cardiomyopathy

We explored sex differences in wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) and determined survival and prognostic factors. In a retrospective cohort study at a reference centre in France from 1 January 2008 to 31 December 2022, multiple regression analyses, supervised clustering, Cox models, and a Kaplan-Meier analysis were used to compare women and men in each age quartile (Q1: ≤77 years; Q2: 78–82; Q3: 83–86; Q4 &gt; 86). We included 1062 patients with ATTRwt-CM (180 women, 16%). The women had a higher median [IQR] left ventricular ejection fraction (LVEF; 52% [45–60] vs. 50 [43–58] in men) and a thinner interventricular septum. 12% of women and 4.1% of men had a septum thickness &lt;12 mm (<i>p</i> = 0.004). The women in Q1 had lower LVEF and global longitudinal strain values and a higher prevalence of a septum &lt;12 mm (15.8%, vs 2.0% in men) than men and older women (Q2-Q3-Q4). Women had a greater risk of sudden death than men (13.8% vs. 4.6%, respectively; odds ratio [95% confidence interval]: 3.24 [1.56–6.64]; <i>p</i> = 0.001). In women, the ATTRwt-CM phenotype and prognosis are related to age at diagnosis. Decreasing the septum thickness cut-off would increase the frequency of ATTR-CM diagnosis in women.