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Right ventricular function analysis in wild-type transthyretin amyloid cardiomyopathy: identifying the best predictor of patient outcomes
Session:
SESSÃO DE POSTERS 06 - AMILOIDOSE CARDÍACA
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:
Cartazes
FP Number:
---
Authors:
Luísa Pinheiro; Margarida de Castro; Emídio Mata; Bárbara Lage Garcia; Tamara Pereira; Filipa Cordeiro; Olga Azevedo; António Lourenço
Abstract
<p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Background: </span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) is an increasingly recognized pathology associated with global cardiac infiltration by amyloid fibrils, including the right ventricle. Right ventricular dysfunction is common in wtATTR-CM and is a predictor of poorer outcomes. Although multiple echocardiographic parameters can assess right ventricular dysfunction, identifying the most reliable parameter for predicting prognosis can be valuable for better patient management.</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 determine which right ventricular echocardiographic parameter is the most reliable predictor of adverse outcomes in wtATTR-CM patients.</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">Baseline echocardiographic parameters were compared between patients who reached the primary endpoint and those who did not. The primary endpoint was the composite endpoint of heart failure hospitalization and all-cause mortality. 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">A total of 111 patients were included in the study (74% males; mean age 81±5 years). Median follow-up was 31 [IQR 16-39] months.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Four echocardiographic parameters were analysed: S' wave, Fractional Area Change (FAC), and Tricuspid Annular Plane Systolic Excursion (TAPSE) and Right ventricular global longitudinal strain (RVGLS). </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Patients who reached the primary endpoint showed significantly worse values for all analyzed parameters:</span></span></p> <ul> <li><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">S’: 9.66 ± 2.90% vs. 12.16 ± 3.6%, p<0.001</span></span></li> <li><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">FAC: 16.12 ± 4.73% vs. 18.59 ± 4.33%, p=0.007</span></span></li> <li><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">TAPSE: 32.12 ± 9.42mm vs. 39.21 ± 9.23mm, p<0.001</span></span></li> <li><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">RVGLS: -10.50 ± 4.09% vs. -12.72 ± 4.64%, p=0.011</span></span></li> </ul> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">ROC analysis identified the best cutoffs for S’ (≤11m/s), FAC (≤39.1%), TAPSE (≤18.7%) and RVGLS (≥-14.5%).</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, FAC was the only independent predictor of the composite endpoint (HR 3.98, 95% CI 1,36-11.63, p=0.012).</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"><span style="color:black">FAC</span> emerged as the most reliable echocardiographic parameter for predicting adverse outcomes in wtATTR-CM patients, highlighting its potential as a valuable tool in clinical decision-making.</span></span></p>
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