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Clinical and echocardiographic prognostic factors in wild type transthyretin cardiac amyloidosis
Session:
Comunicações Orais (Sessão 29) - Doenças do Miocárdio e Pericárdio 2 - Vários Tópicos
Speaker:
Tamara Pereira
Congress:
CPC 2022
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:
Tamara Pereira; Geraldo Dias; Ana Filipa Cardoso; Mariana Tinoco; Olga Azevedo; Francisco Ferreira; António Lourenço
Abstract
<p style="margin-left:24px; text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#333333">Background</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#333333">: </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Transthyretin</span></span> <span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">amyloid cardiomyopathy</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> (ATTR-CM) is an increasingly recognized etiology of heart failure (HF) <span style="color:#2e2e2e">due to the possibility of non-invasive diagnosis and emergence of treatment options. </span>Early recognition and prognosis assessment of ATTR-CM are crucial to guide proper management and treatment. This study aims to identify independent predictors of prognosis in patients with wild-type ATTR-CM.<br /> <br /> <span style="color:#333333"><strong>Methods:</strong> </span><span style="background-color:white"><span style="color:#212529">This is a retrospective single-center study including all patients with diagnosis </span></span><span style="background-color:white"><span style="color:black">of wild-type ATTR-CM </span></span><span style="background-color:white"><span style="color:#212529">between January </span></span><span style="background-color:white"><span style="color:black">2014 and May 2021. ATTR-CM diagnosis was based on the AHA diagnostic criteria. </span></span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">The primary </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">endpoint was the composite endpoint of hospitalization due to HF or death for any cause. </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Clinical, laboratory and echocardiographic data were compared between patients reaching and not reaching primary endpoint in order to identify prognostic factors. Regression analysis was performed to identify independent predictors of prognosis. </span></span><br /> <br /> <strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> 60 patients with wild-type </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#2e2e2e">ATTR-CM were included </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">(mean age 86 ± 5 years, 68.3% males, 56.7 % atrial fibrillation, baseline left ventricular ejection fraction (LVEF) 53% ± 14). </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">The mean follow-up </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">was 30 ± 23 months.</span></span><br /> <span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">During follow-up, the primary endpoint occurred in 37 patients (61.7%); </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">27 patients (45%) died within 2.5 years of their diagnosis, 13 of them (48%) by cardiovascular cause.<strong><u> </u></strong></span></span><br /> <span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Patients reaching the primary endpoint </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">had more commonly a </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">pro-B-type natriuretic peptide (proBNP)<span style="color:black"> above 3000pg/ml (86.7% vs 47.1%, p=0.004) and a higher frequency of left ventricular systolic dysfunction (LVSD) (59.5% vs 17.4%, p=0.0001), right ventricular systolic dysfunction (59.5% vs 30.4%, p=0.029) and CKD (59.5% vs 30.4, p=0.029). </span>In these patients, mean LVEF was lower (47</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">±14% vs 61±10%, p<0.001) and </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">mean global longitudinal strain (GLS) was significantly worse (</span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">-9.7</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">±2.9% vs 14.1±3.8%, p<0.001).</span></span></span></span><br /> <span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Index left ventricular mass was higher (196±47 vs 168±41 p=0.031) as well as right ventricular thickness (10.4 ±1 vs 8.5 ±1, p=0.015).<br /> <span style="color:black">In a multivariate logistic regression analysis, LVSD and pro-BNP value were the only independent predictors of the primary endpoint (HR 7.8 95% CI 1.6–37.8, p=0.011; HR 7.0 95% CI 1.4–34.6,p=0.016, respectively).<br /> <br /> <strong>Conclusions:</strong> LVSD and BNP value are independent predictors of the occurrence of the primary endpoint of hospitalization due to HF or death of any cause in </span><span style="color:#2e2e2e">wild-type ATTR-CM </span>patients. Prospective studies assessing the incremental value of prognostic factors are needed.</span></span></span></span></p>
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