SPC365

Differences between AL and Transthyretin Cardiac Amyloidosis: A comparison of the echocardiographic morphological variables

Session: Posters (Sessão 2 - Écran 7) - Ecocardiografia
Speaker: Ana Beatriz Garcia

Congress: CPC 2023
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Ana Beatriz Garcia; Catarina Simões de Oliveira; Ana Margarida Martins; Beatriz Silva; Pedro Alves da Silva; Joana Brito; Ana Abrantes; Catarina Gregório; João Fonseca; Miguel Raposo; Marta Varela; Diogo Ferreira; João Cravo; Daniel Cazeiro; Rui Plácido; Ana Almeida; Fausto Pinto

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Cardiac amyloidosis (CA) is a restrictive cardiomyopathy caused by myocardial deposition of transthyretin proteins or<strong> </strong>immunoglobulin light chain (AL), associated with poor prognosis. Recent studies have tried to show ventricular and auricular geometry differences between CA subtype, as well as potential differences regarding clinical events, such as atrial fibrillation (AF). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Purpose</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: To identify differences in cardiac geometry of patients (pts) with CA and correlate with clinical outcomes.</span></span>&nbsp; </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> Retrospective, single-center study of pts diagnosed with CA - hereditary (ATTRv), wild- type CA (ATTRwt) or AL &ndash; followed in a tertiary hospital. Clinical, epidemiological and echocardiographic data were collected. Statistical analysis was performed with non-parametric tests (Chi-square and Mann-Whitney). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We included 80 pts (median age 72 years &plusmn; 11; 85% male) with different types of CA &ndash; 42 ATTRv, 21 ATTRwt and 17 AL. Concerning clinical characteristic, 59% had arterial hypertension, 15% diabetes, 44% dyslipidaemia, 6% smoke habits and 50% had chronic kidney disease (eGFR &lt;60 mL/min/m<sup>2</sup>). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We found significant differences regarding left ventricular geometry, with ATTRwt-patients presenting higher index left ventricular mass (186&plusmn;5 vs 148&plusmn;47 vs 167.5&plusmn;43, p=0.003) increased septal and posterior wall thickness (17.7&plusmn;3 vs 15.2&plusmn;3.2 vs 16.1&plusmn;2.3, p=0.035; 15.8&plusmn;3.5 vs 13.5&plusmn;2.5 vs 14.9&plusmn;2.4, p= 0.05, respectively) and lower ejection fraction as well as lower global longitudinal strain (48&plusmn;16.4 vs 57.5&plusmn;8.6 vs 53.9&plusmn;9.9, p=0.028; -10.2&plusmn;4.2 vs -13.7&plusmn;4.3 vs -12.8&plusmn;5.9, p=0.015). Pts with ATTRwt also had higher left atrial volume (p=0.43). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Furthermore, pts with AF had higher E/E&acute; ratio (14&plusmn;7 vs 13.3&plusmn;1.1, p=0.01), higher LA dimensions (p=&lt;0.001) and increased septal thickness (17.1&plusmn;3.5 vs 15.2&plusmn;3.3, p=0.035). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In this analysis, a higher incidence of AF was reported in pts with ATTRwt (18% vs 14% vs 6%, p=&lt;0.001). ATTRwt pts presented higher mortality (p=&lt;0.001) during a mean follow-up of 3 years </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> Our study shows that there are important phenotype divergences according to CA subtypes, such as wall thickness and left atrial dilatation. These geometric differences may help to explain the higher incidence of AF observed in pts with ATTRwt, thereby acting as red flegs during FUP. </span></span></span></span></span></p>