1
|
Banydeen R, Eggleston R, Deney A, Monfort A, Ryu JH, Vergaro G, Castiglione V, Lairez O, Emdin M, Inamo J, Baqir M, Neviere R. Risk Stratification in Transthyretin Cardiac Amyloidosis: The Added Value of Lung Spirometry. J Clin Med 2023; 12:jcm12113684. [PMID: 37297878 DOI: 10.3390/jcm12113684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized disease that often results in heart failure and death. Traditionally, biological staging systems are used to stratify disease severity. Reduced aerobic capacity has recently been described as useful in identifying higher risk of cardiovascular events and death. Assessment of lung volume via simple spirometry might also hold prognostic relevance. We aimed to assess the combined prognostic value of spirometry, cardiopulmonary exercise testing (CPET) and biomarker staging in ATTR-CA patients in a multi-parametric approach. We retrospectively reviewed patient records with pulmonary function and CPET testing. Patients were followed until study endpoint (MACE: composite of heart-failure-related hospitalization and all-cause death) or censure (1 April 2022). In total, 82 patients were enrolled. Median follow-up was 9 months with 31 (38%) MACE. Impaired peak VO2 and forced vital capacity (FVC) were independent predictors of MACE-free survival, with peak VO2 < 50% and FVC < 70% defining the highest risk group (HR 26, 95% CI: 5-142, mean survival: 15 months) compared to patients with the lowest risk (peak VO2 ≥ 50% and FVC ≥ 70%). Combined peak VO2, FVC and ATTR biomarker staging significantly improved MACE prediction by 35% compared to ATTR staging alone, with 67% patients reassigned a higher risk category (p < 0.01). In conclusion, combining functional and biological markers might synergistically improve risk stratification in ATTR-CA. Integrating simple, non-invasive and easily applicable CPET and spirometry in the routine management of ATTR-CA patients might prove useful for improved risk prediction, optimized monitoring and timely introduction of newer-generation therapies.
Collapse
Affiliation(s)
- Rishika Banydeen
- Department of Clinical Research, CHU Martinique (University Hospital of Martinique), 97200 Fort de France, France
- Cardiovascular Research Team EA7525, Université des Antilles (University of the French West Indies), 97200 Fort de France, France
| | - Reid Eggleston
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA
| | - Antoine Deney
- Department of Cardiology, Rangueil Hospital, CHU Toulouse (University Hospital of Toulouse), 31400 Toulouse, France
| | - Astrid Monfort
- Cardiovascular Research Team EA7525, Université des Antilles (University of the French West Indies), 97200 Fort de France, France
- Department of Cardiology, CHU Martinique (University Hospital of Martinique), 97200 Fort de France, France
| | - Jay H Ryu
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA
| | - Giuseppe Vergaro
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanita Pubblica, 56124 Pisa, Italy
| | - Vincenzo Castiglione
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanita Pubblica, 56124 Pisa, Italy
| | - Olivier Lairez
- Department of Cardiology, Rangueil Hospital, CHU Toulouse (University Hospital of Toulouse), 31400 Toulouse, France
| | - Michele Emdin
- Institute of Life Sciences, ScuolaSuperioreSant'Anna, Pisa, Italy & Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Jocelyn Inamo
- Cardiovascular Research Team EA7525, Université des Antilles (University of the French West Indies), 97200 Fort de France, France
- Department of Cardiology, CHU Martinique (University Hospital of Martinique), 97200 Fort de France, France
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA
| | - Remi Neviere
- Cardiovascular Research Team EA7525, Université des Antilles (University of the French West Indies), 97200 Fort de France, France
- Department of Cardiology, CHU Martinique (University Hospital of Martinique), 97200 Fort de France, France
| |
Collapse
|
2
|
Van Iterson EH, Cho L, Tonelli A, Finet JE, Laffin LJ. Alveolar Volume Impairment Affects the Prognostic Value of Peak Exercise Oxygen Uptake in Heart Failure With Reduced Ejection Fraction. J Cardiopulm Rehabil Prev 2022; 42:E103-E105. [PMID: 35861950 DOI: 10.1097/hcr.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Erik H Van Iterson
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leslie Cho
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - J Emanuel Finet
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Luke J Laffin
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
3
|
Patient selection for heart transplant: balancing risk. Curr Opin Organ Transplant 2022; 27:36-44. [PMID: 34939963 DOI: 10.1097/mot.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Heart failure incidence continues to rise despite a relatively static number of available donor hearts. Selecting an appropriate heart transplant candidate requires evaluation of numerous factors to balance patient benefit while maximizing the utility of scarce donor hearts. Recent research has provided new insights into refining recipient risk assessment, providing additional tools to further define and balance risk when considering heart transplantation. RECENT FINDINGS Recent publications have developed models to assist in risk stratifying potential heart transplant recipients based on cardiac and noncardiac factors. These studies provide additional tools to assist clinicians in balancing individual risk and benefit of heart transplantation in the context of a limited donor organ supply. SUMMARY The primary goal of heart transplantation is to improve survival and maximize quality of life. To meet this goal, a careful assessment of patient-specific risks is essential. The optimal approach to patient selection relies on integrating recent prognostication models with a multifactorial assessment of established clinical characteristics, comorbidities and psychosocial factors.
Collapse
|
4
|
Van Iterson EH, Cho L, Tonelli A, Finet JE, Laffin LJ. All-cause mortality predicted by peak oxygen uptake differs depending on spirometry pattern in patients with heart failure and reduced ejection fraction. ESC Heart Fail 2021; 8:2731-2740. [PMID: 33932128 PMCID: PMC8318425 DOI: 10.1002/ehf2.13342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/09/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022] Open
Abstract
Aims In patients with heart failure and reduced ejection fraction (HFrEF), it remains unclear how exacerbated impairments in peak exercise oxygen uptake (V̇O2peak) caused by coexistent obstructive or restrictive ventilatory defects affect mortality risk. We evaluated in patients with HFrEF, whether demonstrating either an obstructive or restrictive‐patterned ventilatory defect on spirometry affects V̇O2peak to yield all‐cause mortality risk predicted by V̇O2peak that is spirometry pattern specific. Methods and results We retrospectively analysed resting spirometry and treadmill cardiopulmonary exercise testing data of patients with HFrEF (left ventricular ejection fraction ≤ 40%). The study sample (N = 329) was grouped by spirometry pattern: normal [Group 1: N = 101; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥ 0.70; FVC ≥ 80% predicted], restrictive without airflow obstruction (Group 2: N = 104; FEV1/FVC ≥ 0.70; FVC < 80% predicted), or obstructive (Group 3: N = 124; FEV1/FVC < 0.70). Patients were followed up to 1 year for the endpoint of all‐cause mortality. V̇O2peak was higher in Group 1 versus Groups 2 and 3 (13.4 ± 4.0 vs. 12.1 ± 3.7 and 12.2 ± 3.3 mL/kg/min, respectively; P = 0.014). Over the 1 year follow‐up, n = 9, n = 16, and n = 12 deaths occurred in Groups 1–3, respectively, with corresponding crude survival rates of 88%, 81%, and 92%, respectively (log‐rank; P = 0.352). V̇O2peak was associated with all‐cause mortality (crude hazard ratio = 0.77; P < 0.001). In multivariate analyses, a significant V̇O2peak‐by‐spirometry group interaction yielded 1.99 (95% confidence interval, 1.14–3.46) and 2.43 (95% confidence interval, 1.44–4.11) higher mortality risk associated with V̇O2peak in Group 2 versus Groups 1 and 3, respectively. Conclusions Demonstrating a restrictive pattern on spirometry yields the severest mortality risk associated with V̇O2peak. Using spirometry to screen patients with HFrEF for ventilatory defects has a potential role in improving risk stratification based on V̇O2peak.
Collapse
Affiliation(s)
- Erik H Van Iterson
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH, 44195, USA
| | - Leslie Cho
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH, 44195, USA
| | | | - J Emanuel Finet
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luke J Laffin
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH, 44195, USA
| |
Collapse
|