SPC365

Prognostic value of global longitudinal strain in patients with transthyretin amyloid cardiomyopathy

Session: Comunicações Orais (Sessão 27) - Imagem 2 - Ecocardiografia e Strain
Speaker: Ana Lobato de Faria Abrantes

Congress: CPC 2022
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Abrantes; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Ana Beatriz Garcia; Catarina Oliveira; Ana Margarida Martins; Miguel Azaredo Raposo; Catarina Gregório; Joana Rigueira; Dulce Brito; Ana g. Almeida; Fausto j. Pinto

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000">: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an important cause of heart failure (HF) in older patients (pts), frequently underdiagnosed, that carries a bad prognosis when untreated. Transthoracic echocardiography (TTE) plays a key role in the diagnosis by allowing early recognition of ATTR-CM findings, like left ventricular hypertrophy (LVH) and apical sparing on global longitudinal strain (GLS).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000"> To evaluate the prognostic value of GLS in a population with ATTR-CM.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000"> Retrospective, single-center study of consecutive pts diagnosed with hereditary ATTR-CM&nbsp; (hATTR-CM) and wild-type ATTR-CM (wtATTR-CM) followed in a tertiary center. We performed speckle tracking strain for GLS using Echopac GE Healthcare software in the diagnostic TTE. Clinical, TTE and epidemiological data were recorded. Statistical analysis was performed with non-parametric tests (Chi-square and Mann-Whitney). Survival analysis was performed with Kaplan-Meier and Cox regression. ROC curves were obtained to determine the optimal cut-off values of GLS.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000"> We included 66 pts, 24 with wtATTR-CM and 42 with hATTR-CM. Mean age was 71&plusmn;12 years, 83.3% being man. Regarding clinical characteristics, 42 pts had hypertension, 12 pts diabetes, 29 pts dyslipidemia, 31 pts chronic kidney disease (eGFR &lt;60 mL/min/m</span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000">), 69.7% pts presented polyneuropathy and 50% autonomic dysfunction. Most of the pts were at NYHA II (54.5%) or III (37.9%). The mean NT-proBNP at diagnosis was 3961&plusmn;6624 pg/mL.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000">At baseline, mean GLS was -12.5&plusmn;4, LVEF 54&plusmn;12.7% and TAPSE 18.5&plusmn;3.5 mm. During a mean follow-up period (FUP) of 22.2&plusmn;22.6 months, 34.5% pts were hospitalized with HF decompensation. Seventeen pts died, most of them had wtATTR-CM (12 vs 5 pts). ATTR-CM pts with GLS&le;-9.0 presented higher risk of mortality during FUP (log rank 19.1, p&lt;0.0001). A cut-off of GLS -9.35 was a strong predictor of mortality in the global population (AUC 0.779, p=0.001, specificity 47% and sensibility 90%, figure 1). On multivariate analysis, NT-proBNP (p=0.001, HR: 1.00, 95%CI: 1-5) and GLS (p=0.0015; HR:1.331, 95%CI: 1.058-1.674)at baseline were independent predictors of mortality as opposed to age and LVEF.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#000000">: Our study shows that pts with ATTR-CM and GLS &le;-9% have a high mortality risk, with GLS -9.35% as a strong predictor of mortality in this subset of pts. Therefore, we found that GLS can be considered a valuable prognostic tool in the assessment of ATTR-CM pts.</span></span></span></p>