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Hemodynamic Profiles and Their Prognostic Relevance in Cardiac Amyloidosis

Franz Duca1, Amir Snidat1, Christina Binder1

  • 1Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria.

Journal of Clinical Medicine
|April 16, 2020
PubMed

Insights

Hemodynamic parameters in cardiac amyloidosis (CA) predict outcomes, especially in wild-type transthyretin amyloidosis (ATTRwt) but not light-chain amyloidosis (AL). Elevated pressures offer potential therapeutic targets in ATTRwt.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Amyloidosis Research

Background:

  • Cardiac amyloidosis (CA) significantly impacts patient prognosis, with hemodynamic parameters being crucial in heart failure (HF).
  • Limited research exists on the specific hemodynamic profiles of CA patients and their prognostic implications across different CA subtypes.
  • Understanding these profiles is vital for improving patient outcomes and developing targeted therapies.

Purpose of the Study:

  • To characterize cardiac amyloidosis patients based on hemodynamic parameters.
  • To assess the prognostic impact of these hemodynamic parameters in wild-type transthyretin amyloidosis (ATTRwt) and light-chain amyloidosis (AL) cohorts.
  • To explore potential new therapeutic targets within CA based on hemodynamic findings.

Main Methods:

  • Invasive hemodynamic assessments, clinical evaluations, laboratory tests, and cardiac magnetic resonance imaging were conducted.
  • A cohort of 61 CA patients was analyzed, comprising 35 with ATTRwt and 26 with AL.
  • Statistical analysis, including hazard ratio calculations, was used to determine prognostic relevance.

Main Results:

  • ATTRwt patients exhibited lower N-terminal prohormone of brain natriuretic peptide and were less often in NYHA class ≥ III compared to AL patients.
  • Both ATTRwt and AL groups presented with elevated intracardiac and pulmonary arterial pressures (PAPs), with similar overall hemodynamic profiles.
  • Mean PAP and pulmonary vascular resistance independently predicted outcomes in ATTRwt patients, but not in AL patients.

Conclusions:

  • Cardiac ATTRwt and AL patients share elevated intracardiac and PAPs, with comparable hemodynamic profiles.
  • Hemodynamic parameters hold greater prognostic significance in ATTRwt CA, suggesting them as potential therapeutic targets.
  • This highlights a key difference in the prognostic relevance of hemodynamics between CA subtypes.

Keywords:
cardiac amyloidosisinvasive hemodynamicsoutcomespulmonary arterial pressures

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