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Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Non-invasive predictors of survival in cardiac amyloidosis
Arnt V Kristen1, Jolanta B Perz, Stefan O Schonland
1Department of Cardiology, Angiology, and Respiratory Medicine, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
Insights
Cardiac amyloidosis (CA) has poor prognosis. Left ventricular ejection fraction (LV-EF) and low voltage pattern (LVP) identify high-risk patients for targeted therapies like heart transplantation.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Diagnostics
Background:
- Cardiac amyloidosis (CA) is associated with significantly increased patient mortality.
- Accurate risk stratification is crucial for managing CA patients.
Purpose of the Study:
- To evaluate clinical, electrocardiographic, and echocardiographic parameters for risk-stratification in cardiac amyloidosis.
- To identify independent predictors of survival in CA patients.
Main Methods:
- Endomyocardial biopsy confirmed CA in 59 patients (light-chain amyloidosis [LCAM] n=43; transthyretin amyloidosis [TAM] n=16).
- Clinical, ECG, and echocardiographic data were analyzed for prognostic significance.
- Multivariate analysis identified key survival predictors.
Main Results:
- LCAM patients had lower 1-/3-year survival (68%/63%) compared to TAM patients (91%/83%).
- Survival was influenced by left ventricular ejection fraction (LV-EF), LV mass, NYHA class, low voltage pattern (LVP), and conduction delay.
- Multivariate analysis identified LV-EF and LVP as independent predictors of survival in all CA patients, along with amyloid etiology.
Conclusions:
- Cardiac amyloidosis carries a poor prognosis.
- Amyloid etiology, LVP, and LV-EF are critical for identifying high-risk patients.
- Early identification may guide individualized treatment strategies, including heart transplantation before causative therapy.
Background:
Patients with cardiac amyloidosis (CA) have increased mortality.
Aims:
Clinical, electrocardiographic, and echocardiographic parameters were assessed for risk-stratification of CA.
Methods And Results:
CA was confirmed by endomyocardial biopsy in 59 patients (54.8+/-1.2 years) with light-chain (n = 43) or transthyretin amyloidosis (n = 16). Six patients without CA served as controls (NCA). Clinical symptoms, electrocardiographic, and echocardiographic parameters were analyzed for prognostic significance. Of the patients with light-chain amyloidosis, 14 died and 2 underwent heart transplantation. 1-/3-year survival was 68%/63%. Survival depended on left ventricular function (LV-EF), LV mass, radius/wall thickness, septum thickness, low voltage pattern (LVP), conduction delay, NYHA class, and stem cell transplantation. A multivariate model only contained LV-EF and LVP; the beneficial effect of stem cell transplantation was cancelled out as this treatment was withheld in patients with highest cardiac risk. Survival was most limited if both risk factors occurred. Cardiac involvement in transthyretin amyloidosis showed better survival (2 deaths, 1-/3-year survival 91%/83%). Analysis of prognostic risk factor utility in all amyloid patients (light-chain and transthyretin) again revealed LVP and LV-EF, and aetiology of amyloidosis as independent survival parameters.
Conclusion:
Prognosis of CA is poor, but aetiology of amyloid, LVP, and LV-EF allows identification of patients at highest risk of death, who may require individual treatment approaches (heart transplantation prior to causative therapy).
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