SPC365

Echocardiographic predictors of death in wild-type transthyretin amyloid cardiomyopathy

Session: SESSÃO DE COMUNICAÇÕES ORAIS 06 – EXPLORANDO A AMILOIDOSE CARDÍACA: INOVAÇÕES NO DIAGNÓSTICO, PROGNÓSTICO E TRATAMENTO
Speaker: Luísa Pinheiro

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 17. Myocardial Disease
Subtheme: 17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Luísa Pinheiro; Margarida de Castro; Emídio Mata; Bárbara Lage Garcia; Tamara Pereira; Filipa Cordeiro; Olga Azevedo; António Lourenço

<p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Background:&nbsp;</span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) is associated with high mortality. Although staging systems using biomarkers like NT-pro-B-type natriuretic peptide (NTproBNP) and estimated glomerular filtration rate (eGFR) have been used to assess disease severity, accurately predicting the prognosis in wtATTR-CM remains a challenge. Echocardiographic parameters, however, offer valuable insights into the prognosis of these patients.</span></span></p>

<p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Purpose:&nbsp;</span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">This study aimed to assess the impact of echocardiographic parameters on the prognosis of wtATTR-CM patients. </span></span></p>

<p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Methods:&nbsp;</span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Retrospective, single-center study of patients with diagnosis of wtATTR-CM between 2014 and 2024. The primary endpoint was the death from any cause. Baseline echocardiographic parameters were compared between patients who reached the primary endpoint and those who did not. ProBNP and eGFR values were also assessed. Regression analyses were performed to identify independent predictors of death.</span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong>&nbsp;</span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">A total of 111 patients were included in the study (74% males; mean age 81&plusmn;5 years). Median follow-up was 31 [IQR 16-39] months. In this study, forty-six patients (41%) <span style="background-color:white"><span style="font-family:&quot;Aptos Display&quot;,sans-serif"><span style="color:black">achieved the primary endpoint</span></span></span><span style="font-family:&quot;Aptos Display&quot;,sans-serif">.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:&quot;Aptos Display&quot;,sans-serif">Patients who achieved the primary endpoint had significant higher prevalence of </span>significant aortic stenosis (AS), defined by moderate or severe AS (59% vs. 37.5%, p=0.031). These patients also had higher interventricular septal wall thickness (19 <span style="color:black">&plusmn; 3.6 vs. 17.7 &plusmn; 3.1, </span>p=0.041) and average E/e&rsquo; (18.2 <span style="color:black">&plusmn; 4.4 vs. 13.5 &plusmn; 6.2, p&lt;0.001)</span>. They exhibited worse right ventricular global longitudinal strain (RV GLS) (-10.4 <span style="color:black">&plusmn; 4.3% vs</span> 12.7 <span style="color:black">&plusmn; 4.6%, </span>p=0.010), tricuspid annular plane systolic excursion (TAPSE) (16.2 <span style="color:black">&plusmn; 4.6mm vs. 18.4 &plusmn; 4.5mm, p=0.016), left ventricular global longitudinal strain (LV GLS) &nbsp;(-10.2 &plusmn; 4.1% vs. -11.8 &plusmn; 3.6%, p=0.034), </span>peak atrial longitudinal strain (PALS) (7.8 <span style="color:black">&plusmn; 5.1% vs.11.5 &plusmn; 6.2, p=0.002) and </span>left atrium total emptying fraction (LATEF) (24.3 &plusmn; 12.3% vs. 34 &plusmn; 14.4%, p&lt;0.001).</span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:&quot;Aptos Display&quot;,sans-serif">Multivariate regression analysis, that included </span>ProBNP&nbsp;and eGFR,<span style="font-family:&quot;Aptos Display&quot;,sans-serif"> revealed that average E/e&rsquo; (HR 1.17, 95% CI 1.04-1.33, p=0.013) and </span>RV GLS<span style="font-family:&quot;Aptos Display&quot;,sans-serif"> (HR 0.82, 95% CI 0.67-0.99, p=0.045) were independent predictors of death.</span></span></span></p>

<p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Conclusions:&nbsp;</span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">These findings highlight the potential role of RV GLS and <span style="font-family:&quot;Aptos Display&quot;,sans-serif">E/e&rsquo; </span>in assessing the prognosis of wtATTR-CM patients. Such echocardiographic parameters could be further integrated into existing staging system to better predict outcomes and guide clinical management.</span></span></p>