First-phase ejection fraction as a potential early indicator for left ventricular function in cardiac amyloidosis
Tongtong Huang1, Chunxiao Su1, Chunlan Jiang1
1Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Insights
Left ventricular first-phase ejection fraction (LVEF1) is a sensitive indicator for cardiac amyloidosis (CA). Lower baseline LVEF1 predicts poor prognosis in light-chain CA patients, aiding treatment decisions.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Hematology
Background:
- Cardiac amyloidosis (CA) significantly impacts prognosis in light-chain amyloidosis.
- Left ventricular first-phase ejection fraction (LVEF1) is a more sensitive indicator than ejection fraction for CA.
- This study investigates the utility of LVEF1 in guiding treatment and prognosis for light-chain CA.
Purpose of the Study:
- To evaluate the role of LVEF1 in assessing left ventricular function in patients with suspected cardiac amyloidosis.
- To determine the prognostic value of LVEF1 in light-chain cardiac amyloidosis.
- To assess the impact of treatment on LVEF1 and its correlation with treatment response.
Main Methods:
- 119 patients with light-chain amyloidosis and suspected CA were enrolled.
- Diagnosis was confirmed via cardiac magnetic resonance or abdominal fat biopsy.
- LVEF1, echocardiography, and biochemical data were analyzed pre- and post-chemotherapy.
Main Results:
- Patients with CA had significantly lower baseline LVEF1 compared to non-CA patients (31.35% vs. 36.25%).
- LVEF1 improved in patients achieving hematologic complete response (hemCR) after treatment (32.62% to 39.24%).
- Baseline LVEF1 <30% was associated with elevated NT-proBNP, reduced GLS, and increased mortality risk.
Conclusions:
- LVEF1 serves as an early indicator of left ventricular dysfunction in CA patients with preserved ejection fraction.
- LVEF1 can detect subtle changes in cardiac function and predict prognosis.
- LVEF1 is a valuable tool for managing light-chain cardiac amyloidosis.
Background:
Cardiac amyloidosis (CA) is crucial for prognosis in patients with light-chain amyloidosis, with left ventricular first-phase ejection fraction (LVEF1) being a more sensitive indicator for this condition than ejection fraction. This study aimed to assess LVEF1's value in informing the treatment and prognosis of patients with light-chain CA.
Methods:
A total of 119 patients with light-chain amyloidosis and LVEF ≥50% and suspected CA according to echocardiography were enrolled. After validation via cardiac magnetic resonance (CMR) or abdominal fat biopsy, these patients were split into a CA group (n=72) and non-CA group (n=47). Based on first hospitalization, echocardiography and blood biochemical data were obtained. After 1 year of chemotherapy, echocardiography and biochemical data were obtained again, and patients were divided into hematologic complete response (hemCR; n=26) and non-hemCR (n=38) groups. Analyses of subgroups comparing pre- and posttreatment were conducted, followed by survival analysis in all patients with CA (followed up until September 30, 2024).
Results:
Compared to the non-CA group, the CA group had a lower LVEF1 (31.35%±7.78% vs. 36.25%±8.74%; P<0.01). After 1 year of treatment, the LVEF1 in the hemCR group improved compared to that a year prior (32.62%±8.13% to 39.24%±7.36%; P<0.01), and the change in LVEF1 correlated with the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) (r=-0.761). During follow-up, 30 patients died (8 during the 1 year of treatment and 22 during the median 18-month posttreatment follow-up). Baseline LVEF1 had discriminatory ability for poor prognosis (hazard ratio =0.92, 95% confidence interval: 0.88-0.97; P=0.003). The optimal LVEF1 (Youden index) cutoff was 30%. Patients with CA and a baseline LVEF1 <30% demonstrated elevated NT-proBNP level, reduced left ventricular global longitudinal strain, and increased mortality risk.
Conclusions:
LVEF1 has the potential to be an early indicator of left ventricular function in patients with CA and preserved ejection fraction. It can both reflect subtle left ventricular function changes and aid in predicting prognosis.
