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Predictors of atrial fibrillation 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; Barbara Lage Garcia; Tamara Pereira; Filipa Cordeiro; Olga Azevedo; António Lourenço
Abstract
<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong> </span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">In wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) the cardiac infiltration by amyloid fibrils leads to increased stiffness of the atrial walls and diastolic dysfunction. This leads to a high prevalence of atrial fibrillation (AF) in these patients.</span></span></p> <p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Purpose: </span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">To identify predictors of AF occurrence in patients with wtATTR-CM.</span></span></p> <p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Methods: </span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Retrospective, single-center study of patients with the diagnosis of wtATTR-CM between 2014 and 2024 who were in sinus rhythm at the time of the diagnosis. Data on clinical, laboratory, and echocardiographic parameters were collected and compared between patients who developed AF vs. did not develop AF. Regression analyses were used to determine the independent predictors of the primary endpoint.</span></span></p> <p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Results: </span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Out of 111 patients, 59 patients were in sinus rhythm at the diagnosis (73% males, mean age 80 ± 6 years). The median follow up was 30 [IQR 16-36] months. During follow-up 30 patients (51%) developed AF.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Patients who developed AF had a higher prevalence of chronic kidney disease (CKD) (50% vs 24%, p=0.024). The use of spironolactone (14% vs 37%, p=0.044) and beta blockers (21% vs 50%, p=0.011) was less common in those who developed AF. Regarding echocardiographic parameters, those who developed AF had higher average E/e’ (17 ± 6.5 vs. 13 ± 6, p=0.033), worst PALS (12.1 ± 4.5% vs. 15.5 ± 6.1%, p=0.034), PACS (-6.3 ± 3.8% vs. -9 ± 5,5%, p=0.03) and left atrium total emptying fraction (LATEF) (35 ± 12.3% vs. 41.6 ± 12.2%, p=0.047).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Aptos Display",sans-serif">On </span><span style="color:black">multivariate regression analysis, CKD was an independent predictor of AF (OR 6.20, 95% CI 1,276-30.142, p=0.04). The use of beta-blockers was a protective factor against AF (OR 0.10, 95% CI 0.017-0.585, p=0.019). Additionally, higher E/e’ ratio (OR 1.17, 95% CI 1.013-1.355, p=0.039) and </span>worst<span style="color:black"> PACS (OR 1.328, 95% CI 1.005-1.755, p=0.046) were also independent predictors of AF.</span></span></span></p> <p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Conclusions: </span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">The study suggests that atrial deformation analysis, along with diastolic dysfunction assessment, can be valuable tools in predicting the risk of AF in wtATTR-CM patients. The use of beta-blockers in these patients may offer a protective effect, supported by recent studies suggesting that beta-blocker therapy could provide beneficial prognostic value.</span></span></p>
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