Estimated Stressed Blood Volume in Patients With Cardiac Amyloidosis

Area of Science:

• Cardiology
• Cardiovascular Physiology
• Amyloidosis Research

Background:

• Cardiac amyloidosis (CA) presents unique hemodynamic profiles distinct from typical heart failure.
• Stressed blood volume significantly influences intravascular pressures and cardiac filling.
• Understanding these derangements is crucial for CA patient management and outcome prediction.

Purpose of the Study:

• To investigate the utility of estimated stressed blood volume (eSBV) in assessing hemodynamic alterations in CA patients.
• To determine the association between eSBV and adverse outcomes, specifically all-cause mortality.
• To explore the differential impact of eSBV on mortality across varying left ventricular ejection fraction (LVEF) levels.

Main Methods:

• Retrospective review of 462 patients undergoing right heart catheterization.
• Calculation of eSBV using standard hemodynamic measurements.
• Stratification of patients into high and low eSBV groups.
• Analysis of all-cause mortality as the primary outcome, stratified by LVEF (>40% vs. ≤40%).

Main Results:

• The final cohort comprised 388 CA patients (225 transthyretin, 163 light-chain).
• In patients with LVEF >40%, high eSBV was linked to significantly higher adverse event rates (log-rank p=0.018).
• Higher eSBV independently predicted all-cause mortality in the LVEF >40% group (HR 2.19, p=0.012), but not in the LVEF ≤40% group.

Conclusions:

• Estimated stressed blood volume is an independent predictor of mortality in cardiac amyloidosis patients with preserved LVEF (>40%).
• eSBV offers prognostic value beyond traditional risk factors and LVEF.
• Integrating eSBV into hemodynamic assessments may enhance treatment decisions and prognosis in CA management.