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Microvascular obstruction in cardiac amyloidosis
Lucrezia Netti1, Adam Ioannou2, Ana Martinez-Naharro2
1Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
European Journal of Heart Failure
|October 18, 2024
Summary
Microvascular obstruction (MVO) is prevalent in cardiac amyloidosis (CA), particularly in transthyretin CA. MVO is linked to worse outcomes in light-chain CA but not transthyretin CA, highlighting distinct disease mechanisms.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Pathology
Background:
- Cardiac amyloidosis (CA) involves amyloid fibril deposition, disrupting myocardial and capillary structures.
- Understanding microvascular obstruction (MVO) prevalence and prognostic implications in CA is crucial.
Purpose of the Study:
- To determine the prevalence of MVO in patients with CA.
- To assess the association between MVO and prognosis in different types of CA.
Main Methods:
- Retrospective analysis of 800 patients with CA (400 AL-CA, 400 ATTR-CA).
- Evaluation of MVO presence and its correlation with clinical, imaging, and biomarker data.
- Prognostic analysis using survival data.
Main Results:
- MVO was identified in 27.6% of patients, more common in transthyretin CA (ATTR-CA) than light-chain CA (AL-CA).
- Patients with MVO exhibited a more severe cardiac phenotype, including elevated NT-proBNP and reduced global longitudinal strain.
- MVO was associated with increased mortality risk in AL-CA but not ATTR-CA.
Conclusions:
- Microvascular obstruction is a frequent finding in cardiac amyloidosis, associated with markers of amyloid infiltration.
- MVO portends a worse prognosis in AL-CA, suggesting distinct pathophysiological mechanisms compared to ATTR-CA.
- These findings underscore the heterogeneity of CA and the multifaceted role of MVO in disease progression.
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