Green tea halts progression of cardiac transthyretin amyloidosis: an observational report

Abstract

Background: Treatment options in patients with amyloidotic transthyretin (ATTR) cardiomyopathy are limited. Epigallocatechin-3-gallate (EGCG), the most abundant catechin in green tea (GT), inhibits fibril formation from several amyloidogenic proteins in vitro. Thus, it might also halt progression of TTR amyloidosis. This is a single-center observational report on the effects of GT consumption in patients with ATTR cardiomopathy.

Methods: 19 patients with ATTR cardiomyopathy were evaluated by standard blood tests, echocardiography, and cardiac MRI (n = 9) before and after consumption of GT and/or green tea extracts (GTE) for 12 months.

Results: Five patients were not followed up for reasons of death (n = 2), discontinuation of GT/GTE consumption (n = 2), and heart transplantation (n = 1). After 12 months no increase of left ventricular (LV) wall thickness and LV myocardial mass was observed by echocardiography. In the subgroup of patients evaluated by cardiac MRI a mean decrease of LV myocardial mass (-12.5 %) was detected in all patients. This was accompanied by an increase of mean mitral annular systolic velocity of 9 % in all 14 patients. Total cholesterol (191.9 ± 8.9 vs. 172.7 ± 9.4 mg/dL; p < 0.01) and LDL cholesterol (105.8 ± 7.6 vs. 89.5 ± 8.0 mg/dL; p < 0.01) decreased significantly during the observational period. No serious adverse effects were reported by any of the participants.

Conclusions: Our observation suggests an inhibitory effect of GT and/or GTE on the progression of cardiac amyloidosis. We propose a randomized placebo-controlled investigation to confirm our observation.

Fig. 1

Whole body scintigraphy for visualization of cardiac transthyretin amyloid Cardiac tracer uptake obtained 3 h after application of 736 MBq technetium-99 m 3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD) indicating cardiac ATTR amyloid deposition

Fig. 2

Changes of lipid profile during the study period Total cholesterol (a) and LDL cholesterol (b) plasma levels of patients with TTR amyloidosis before (t ₀) and after 12 months (t ₁₂) of green tea consumption

Fig. 3

Echocardiographic changes during the study period (a) Interventricular septum thickness, (b) posterior wall thickness, (c) left ventricular myocardial mass, and (d) systolic velocity of the lateral mitral annulus (MASV) assessed by echocardiography in patients with TTR amyloidosis before (t ₀) and after 12 months (t ₁₂) of green tea consumption

Fig. 4

MRI changes during the study period left ventricular (LV) myocardial mass assessed by cardiac MRI in patients with TTR amyloidosis before (t ₀) and after 12 months (t ₁₂) of green tea consumption