New data presented at the European Society of Cardiology Congress 2025 identified a sex-based disparity in the diagnosis of transthyretin cardiac amyloidosis (ATTR-CM). The analysis from the University of Duisburg-Essen included 240 patients diagnosed between 2018 and 2024, of whom 34 (14.2%) were women. Age and body mass index (BMI) were comparable between sexes. Women were less frequently diagnosed during the earlier period (2018 to June 2021), although representation increased in more recent years. Median time to diagnosis in women decreased from 750 days in the early phase to 86 days in the later phase.

Echocardiographic findings showed that women had lower interventricular septal thickness (15.9 ± 4.5 mm vs. 18.1 ± 4.5 mm), higher left ventricular ejection fraction (55% vs. 51.7%), lower stroke volume, and reduced left ventricular mass compared with men. Women also had lower troponin I levels and lower estimated glomerular filtration rate (eGFR). These differences persisted after six months of transthyretin stabilizer therapy.

The analysis suggested that reliance on a septal wall thickness threshold of ≥12 mm, applied across sexes, may contribute to underdiagnosis in women with ATTR-CM. The findings support consideration of sex-specific diagnostic thresholds to improve detection.

These findings from the ESC Congress 2025 highlight the importance of incorporating sex-specific cardiac characteristics into screening approaches for ATTR-CM.