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Badwan O, Berglund F, Rosenzveig A, Persits I, Gharaibeh A, Kumar A, Agrawal A, Sul L, Chan N, Wang TKM, Hanna M, Klein AL. Pericardial Disease in Cardiac Amyloidosis: A Comprehensive Review. Am J Cardiol 2024; 223:100-108. [PMID: 38740164 DOI: 10.1016/j.amjcard.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological mechanisms of pericardial pathology in cardiac amyloidosis include chronic elevations in right-sided filling pressures, myocardial and pericardial inflammation due to cytotoxic effects of amyloid deposits, and renal involvement with subsequent uremia and hypoalbuminemia. The pericardial effusions are typically small; however, several cases of life-threatening cardiac tamponade with hemorrhagic effusions have been described as a presenting clinical scenario. Constrictive pericarditis can also occur due to amyloidosis and its identification presents a clinical challenge in patients with cardiac amyloidosis who concurrently manifest signs of restrictive cardiomyopathy. Multimodality imaging, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is useful in the evaluation and management of this patient population. The recognition of pericardial effusion is important in the risk stratification of patients with cardiac amyloidosis as its presence confers a poor prognosis. However, specific treatment aimed at the effusions themselves is seldom indicated. Cardiac tamponade and constrictive pericarditis may necessitate pericardiocentesis and pericardiectomy, respectively.
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Affiliation(s)
- Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Felix Berglund
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Akiva Rosenzveig
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ian Persits
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmad Gharaibeh
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ashwin Kumar
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankit Agrawal
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lidiya Sul
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicholas Chan
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mazen Hanna
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Lalario A, Saro R, Sinagra G, Merlo M, Porcari A. Clinical Use of Biomarkers in Cardiac Amyloidosis. Heart Fail Clin 2024; 20:283-294. [PMID: 38844299 DOI: 10.1016/j.hfc.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Amyloidosis is a systemic condition characterized by multiple organs involvement. A multidisciplinary and multimodal approach in assessing patients is pivotal and recommended by the international scientific societies. Biomarkers represent an essential noninvasive tool to increase the suspicion of disease and orient further workup and clinical management of patients. This review provides an updated contemporary focus on the clinical use of biomarkers in cardiac amyloidosis, emphasizing their role in both the diagnostic and prognostic setting and discussing future perspective of emerging biomarkers.
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Affiliation(s)
- Andrea Lalario
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100, Trieste, Italy; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Via P. Valdoni 7, 34100, Trieste, Italy
| | - Riccardo Saro
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100, Trieste, Italy; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Via P. Valdoni 7, 34100, Trieste, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100, Trieste, Italy; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Via P. Valdoni 7, 34100, Trieste, Italy
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100, Trieste, Italy; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Via P. Valdoni 7, 34100, Trieste, Italy
| | - Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100, Trieste, Italy; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Via P. Valdoni 7, 34100, Trieste, Italy; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
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De Michieli L, Cipriani A, Iliceto S, Dispenzieri A, Jaffe AS. Cardiac Troponin in Patients With Light Chain and Transthyretin Cardiac Amyloidosis: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024; 6:1-15. [PMID: 38510286 PMCID: PMC10950441 DOI: 10.1016/j.jaccao.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 03/22/2024] Open
Abstract
Cardiac amyloidosis (CA) is an infiltrative disease caused by amyloid fibril deposition in the myocardium; the 2 forms that most frequently involve the heart are amyloid light chain (AL) and amyloid transthyretin (ATTR) amyloidosis. Cardiac troponin (cTn) is the biomarker of choice for the detection of myocardial injury and is frequently found to be elevated in patients with CA, particularly with high-sensitivity assays. Multiple mechanisms of myocardial injury in CA have been proposed, including cytotoxic effect of amyloid precursors, interstitial amyloid fibril infiltration, coronary microvascular dysfunction, amyloid- and non-amyloid-related coronary artery disease, diastolic dysfunction, and heart failure. Regardless of the mechanisms, cTn values have relevant prognostic (and potentially diagnostic) implications in both AL and ATTR amyloidosis. In this review, the authors discuss the significant aspects of cTn biology and measurement methods, potential mechanisms of myocardial injury in CA, and the clinical application of cTn in the management of both AL and ATTR amyloidosis.
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Affiliation(s)
- Laura De Michieli
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
- Cardiovascular Department, Mayo Clinic and Medical School, Rochester, Minnesota, USA
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
- Cardiology Unit, University Hospital of Padua, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
- Cardiology Unit, University Hospital of Padua, Padua, Italy
| | | | - Allan S. Jaffe
- Cardiovascular Department, Mayo Clinic and Medical School, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic and Medical School, Rochester, Minnesota, USA
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Scirpa R, Cittadini E, Mazzocchi L, Tini G, Sclafani M, Russo D, Imperatrice A, Tropea A, Autore C, Musumeci B. Risk stratification in transthyretin-related cardiac amyloidosis. Front Cardiovasc Med 2023; 10:1151803. [PMID: 37025682 PMCID: PMC10070959 DOI: 10.3389/fcvm.2023.1151803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Transthyretin related cardiac amyloidosis (TTR-CA) is an infiltrative cardiomyopathy that cause heart failure with preserved ejection fraction, mainly in aging people. Due to the introduction of a non invasive diagnostic algorithm, this disease, previously considered to be rare, is increasingly recognized. The natural history of TTR-CA includes two different stages: a presymptomatic and a symptomatic stage. Due to the availability of new disease-modifying therapies, the need to reach a diagnosis in the first stage has become impelling. While in variant TTR-CA an early identification of the disease may be obtained with a genetic screening in proband's relatives, in the wild-type form it represents a challenging issue. Once the diagnosis has been made, in order to identifying patients with a higher risk of cardiovascular events and death it is necessary to focus on risk stratification. Two prognostic scores have been proposed both based on biomarkers and laboratory findings. However, a multiparametric approach combining information from electrocardiogram, echocardiogram, cardiopulmonary exercise test and cardiac magnetic resonance may be warranted for a more comprehensive risk prediction. In this review, we aim at evaluating a step by step risk stratification, providing a clinical diagnostic and prognostic approach for the management of patients with TTR-CA.
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Affiliation(s)
- Riccardo Scirpa
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Cittadini
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Mazzocchi
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giacomo Tini
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Department of Cardiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Matteo Sclafani
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Domitilla Russo
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Imperatrice
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Tropea
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Beatrice Musumeci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Kraus MJ, Smits JM, Meyer AL, Strelniece A, van Kins A, Boeken U, Reinecke A, Provaznik Z, Van Caenegem O, Ancion A, Berchtold-Herz M, Van Cleemput JJA, Haverich A, Laufer G, Gummert J, Karck M, Warnecke G, Raake PW, Frey N, Kreusser MM. Outcomes in patients with cardiac amyloidosis undergoing heart transplantation: the eurotransplant experience. J Heart Lung Transplant 2023; 42:778-785. [PMID: 36710093 DOI: 10.1016/j.healun.2023.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND When advanced heart failure occurs in cardiac amyloidosis, prognosis is poor. In this setting heart transplantation (HTX) is a treatment option for selected patients. We here present the results of post-transplantation outcomes in cardiac amyloidosis within the Eurotransplant area, investigating possible predictors of survival. METHODS Of 115 patients undergoing HTX due to cardiac amyloidosis in the Eurotransplant region between November 1987 and May 2020, detailed assessment prior to transplantation was available in 85 patients. The present study was conducted in a retrospective approach. Primary endpoint was mortality after HTX. Baseline variables were entered in a Cox proportional hazards model with the primary endpoint as a dependent variable. RESULTS Median overall survival following HTX was 6.3 years in the overall collective and the subgroup. Univariate Cox proportional hazards model revealed a significant relationship between overall survival and the transplantation period (2008 to 2020 vs 1987 to 2007; median survival 9.7 years vs 1.8 years, hazard ratio 0.45, p = 0.01). Further predictors were albumin concentration (hazard ratio 0.92, p < 0.001), and systolic blood pressure (hazard ratio 0.96, p < 0.001). The transplant period as well as albumin concentration remained significant independent predictors in the AL sub cohort in a multivariate Cox proportional hazards model. CONCLUSIONS HTX is a viable treatment option for patients at an advanced stage of cardiac amyloidosis as overall survival after transplantation has improved in the modern age. Patients at a very advanced stage of the disease, indicated by low serum albumin and blood pressure, show worse outcomes following HTX. Optimal timing and careful patient selection may therefore be particularly important to further improve post-HTX survival in amyloidosis patients.
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Affiliation(s)
- Martin J Kraus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany.
| | | | - Anna L Meyer
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | | | | | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
| | - Alexander Reinecke
- Department of Cardiology, Angiology and Intensive Care, University of Kiel, Kiel, Germany
| | - Zdenek Provaznik
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Oliver Van Caenegem
- Cardiovascular Department, Intensive Care Unit, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (deceased)
| | - Arnaud Ancion
- Cardiology, Centre Hospitalier Universitaire Sart-Tilman, Liège, Belgium
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany; Department of Medicine, University Heart Center Freiburg, Freiburg, Germany
| | | | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenther Laufer
- Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Jan Gummert
- Heart and Diabetes Center Nord-Rhein-Westfalen, Ruhr University Bochum, Bochum, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany; Department of Cardiology, University Hospital of Augsburg, Augsburg Germany
| | - Norbert Frey
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
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Antonopoulos AS, Panagiotopoulos I, Kouroutzoglou A, Koutsis G, Toskas P, Lazaros G, Toutouzas K, Tousoulis D, Tsioufis K, Vlachopoulos C. Prevalence and Clinical Outcomes of Transthyretin Amyloidosis: A Systematic Review and Meta-analysis. Eur J Heart Fail 2022; 24:1677-1696. [PMID: 35730461 DOI: 10.1002/ejhf.2589] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Systematic evidence on the prevalence and clinical outcome of transthyretin amyloidosis (ATTR) is missing. We explored: a) the prevalence of cardiac amyloidosis in various patient subgroups, b) survival estimates for ATTR subtypes and c) the effects of novel therapeutics on the natural course of disease. METHODS A systematic review of literature published in Medline before 31/12/2021 was performed for the prevalence of cardiac amyloidosis & all-cause mortality of ATTR patients. Extracted data included sample size, age, sex, and all-cause mortality at 1, 2 and 5-years. Subgroup analyses were performed for ATTR subtype i.e., wild type ATTR (wtATTR) vs. hereditary ATTR (htATTR), htATTR genotypes and treatment subgroups. RESULTS We identified a total of 62 studies (n=277,882 individuals) reporting the prevalence of cardiac amyloidosis, which was high among patients with a hypertrophic cardiomyopathy phenotype, HFpEF, and elderly with aortic stenosis. Data on ATTR mortality were extracted from 95 studies (n=18,238 ATTR patients). Patients with wtATTR were older (p=7x10-10 ) and more frequently male (p=5x10-20 ) vs. htATTR. The 2-year survival of ATTR was 73.3% (95%CI 71.6-76.2); for non-subtyped ATTR 70.4% (95%CI 66.9-73.9), for wtATTR (76.0%, 95%CI: 73.0-78.9) and for htATTR (77.2%, 95%CI: 74.0-80.4); in meta-regression analysis wtATTR was associated with higher survival after adjusting for confounders. There was an interaction between survival and htATTR genotypes (p=10-15 , Val30Met having the lowest and Val122Ile/Thr60Ala the highest mortality). ATTR 2-year survival was higher on tafamidis/patisiran compared to natural disease course (79.9%, 95%CI: 74.4-85.3 vs. 72.4%, 95%CI 69.8-74.9, p<0.05). CONCLUSIONS We report the prevalence of ATTR in various population subgroups and provide survival estimates for the natural course of disease and the effects of novel therapeutics. Important gaps in worldwide epidemiology research in ATTR were identified. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alexios S Antonopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, Hippokration University Hospital, Athens, Greece
| | - Ioannis Panagiotopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, Hippokration University Hospital, Athens, Greece
| | - Alexandrina Kouroutzoglou
- 1st Cardiology Department, National and Kapodistrian University of Athens, Hippokration University Hospital, Athens, Greece
| | - Georgios Koutsis
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition University Hospital, Athens, Greece
| | - Pantelis Toskas
- 1st Cardiology Department, National and Kapodistrian University of Athens, Hippokration University Hospital, Athens, Greece
| | - Georgios Lazaros
- 1st Cardiology Department, National and Kapodistrian University of Athens, Hippokration University Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- 1st Cardiology Department, National and Kapodistrian University of Athens, Hippokration University Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens, Hippokration University Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Department, National and Kapodistrian University of Athens, Hippokration University Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, Hippokration University Hospital, Athens, Greece
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Gill SS, Fellin E, Stampke L, Zhao Y, Masri A. Clinical Clues and Diagnostic Workup of Cardiac Amyloidosis. Methodist Debakey Cardiovasc J 2022; 18:36-46. [PMID: 35414856 PMCID: PMC8932349 DOI: 10.14797/mdcvj.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
Cardiac amyloidosis is increasingly recognized as an underlying cause of left ventricular wall thickening, heart failure, and arrhythmia with variable clinical presentation. Due to the subtle cardiac findings in early transthyretin cardiac amyloidosis and the availability of therapies that can modify but not reverse the disease progression, early recognition is vital. In light chain amyloidosis, timely diagnosis and treatment can significantly improve survival. In this manuscript, we review the clinical, imaging, and electrocardiographic clues that should raise suspicion for cardiac amyloidosis and provide a simplified diagnostic workup algorithm that ensures an accurate diagnosis. The evolution of the noninvasive diagnosis of cardiac amyloidosis has significantly influenced our understanding of disease prevalence, presentations, and outcomes. However, clinical recognition of clues and red flags remains the most important factor in advancing the care of patients with cardiac amyloidosis.
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Affiliation(s)
- Sajan S. Gill
- Knight Cardiovascular Institute, Oregon Health & Science University School of Medicine, Portland, Oregon, US
| | - Eric Fellin
- Oregon Health & Science University School of Medicine, Portland, Oregon, US
| | - Lisa Stampke
- Oregon Health & Science University School of Medicine, Portland, Oregon, US
| | - Yunazi Zhao
- Knight Cardiovascular Institute, Oregon Health & Science University School of Medicine, Portland, Oregon, US
| | - Ahmad Masri
- Knight Cardiovascular Institute, Oregon Health & Science University School of Medicine, Portland, Oregon, US
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Ogasawara K, Shiraishi S, Tsuda N, Sakamoto F, Oda S, Takashio S, Tsujita K, Hirai T. Usefulness of quantitative 99mTc-pyrophosphate SPECT/CT for predicting the prognosis of patients with wild-type transthyretin cardiac amyloidosis. Jpn J Radiol 2022; 40:508-517. [PMID: 34973114 PMCID: PMC9068718 DOI: 10.1007/s11604-021-01221-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/12/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Wild-type transthyretin-related amyloidosis cardiomyopathy (ATTRwt-CM) is an increasingly recognized cause of heart failure especially in elderly patients. The purpose of the present study was to determine retrospectively whether the quantitative indices of 99mTc-pyrophosphate (PYP) SPECT/CT help to predict the prognosis of ATTRwt-CM patients when compared with other clinical parameters. MATERIALS AND METHODS Sixty-eight patients with biopsy-proven ATTRwt-CM who underwent PYP SPECT/CT were enrolled. Baseline clinical characteristics, echocardiographic parameters, and qualitative and/or quantitative indices of planar and SPECT/CT imaging in PYP scintigraphy for each patient were included. For quantitative analysis of SPECT/CT, the accumulation ratio of PYP in the septum, posterior, anterior, lateral, and apex walls to the cavity pool was calculated as the septal wall-to-cavity ratio (Se/C), lateral wall-to-cavity ratio (La/C), anterior wall-to-cavity ratio (An/C), inferior wall-to-cavity ratio (In/C), and apical wall-to-cavity ratio (Ap/C), respectively. Endpoints for prognostic accuracy evaluation were cardiac death or hospitalization due to heart failure. Event-free survival rate was evaluated through Cox proportional hazards regression analysis, providing estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and Kaplan-Meier curves. RESULTS High-sensitivity cardiac troponin T (hs-cTnT), La/C, age, interventricular septal thickness in diastole, and E/e' ratio in the septal wall were significantly associated with event-free survival (P < 0.05). For a multivariable Cox proportional hazards analysis, hs-cTnT (HR 1.153; 95% CI 1.034-1.286; P < 0.01), La/C (HR 2.091; 95% CI 1.012-4.322; P = 0.046), and age (HR 1.116; 95% CI 1.007-1.238; P = 0.037) were significant independent prognostic factors. CONCLUSION This study indicated that the quantitative indices of PYP SPECT/CT can help to predict the prognosis of ATTRwt-CM patients.
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Affiliation(s)
- Kouji Ogasawara
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan.
| | - Noriko Tsuda
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Fumi Sakamoto
- Department of Diagnostic Medical Imaging, School of Health Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Seitarou Oda
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
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Oghina S, Josse C, Bézard M, Kharoubi M, Delbarre MA, Eyharts D, Zaroui A, Guendouz S, Galat A, Hittinger L, Fanen P, Teiger E, Mouri N, Montestruc F, Damy T. Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide and High-Sensitivity Troponin T Levels in the Natural History of Transthyretin Amyloid Cardiomyopathy and Their Evolution after Tafamidis Treatment. J Clin Med 2021; 10:jcm10214868. [PMID: 34768388 PMCID: PMC8584290 DOI: 10.3390/jcm10214868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We assesse the evolution and prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (cTnT-HS) in transthyretin amyloid cardiomyopathy (ATTR-CA) before and after tafamidis treatment. METHODS AND RESULTS 454 ATTR-CA patients without tafamidis (Cohort A) and 248 ATTR-CA with tafamidis (Cohort B) were enrolled. Event-free survival (EFS) events were death, heart transplant, or acute heart failure. In Cohort A, 27% of patients maintained NT-proBNP < 3000 ng/L and 14% cTnT-HS < 50 ng/L at 12 months relative to baseline levels. In Cohort B, the proportions were 49% and 29%, respectively. In Cohort A, among the 333 patients without an increased NT-proBNP > 50% relative to baseline EFS was extended compared to the 121 patients with an increased NT-proBNP > 50% (HR: 0.75 [0.57; 0.98]; p = 0.032). In Cohort A, baseline NT-proBNP > 3000 ng/L and cTnT-HS > 50 ng/L and a relative increase of NT-proBNP > 50% during follow-up were independent prognostic factors of EFS. The slopes of logs NT-proBNP and cTnT-HS increased with time before and stabilized after tafamidis. CONCLUSION ATTR-CA patients with increasing NT-proBNP had an increased risk of EFS. Tafamidis stabilize NT-proBNP and cTnT-HS increasing, even if initial NT-proBNP levels were >3000 ng/L. Thus suggesting that all patients, irrespective of baseline NT-proBNP levels, may benefit from tafamidis.
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Affiliation(s)
- Silvia Oghina
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Correspondence: ; Tel.: +33-1498-122-53; Fax: +33-1498-142-24
| | | | - Mélanie Bézard
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Mounira Kharoubi
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Marc-Antoine Delbarre
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Damien Eyharts
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Amira Zaroui
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Soulef Guendouz
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Arnault Galat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Luc Hittinger
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Pascale Fanen
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Genetics Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Emmanuel Teiger
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Nadir Mouri
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Biochemistery Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | | | - Thibaud Damy
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
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10
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Kreusser MM, Hamed S, Weber A, Schmack B, Volz MJ, Geis NA, Grossekettler L, Pleger ST, Ruhparwar A, Katus HA, Raake PW. MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure. ESC Heart Fail 2020; 7:3891-3900. [PMID: 33107214 PMCID: PMC7754960 DOI: 10.1002/ehf2.12982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/29/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
Aims Mitral valve regurgitation (MR) is common in patients with advanced heart failure (HF). Percutaneous mitral valve repair (PMVR) via MitraClip (MC) has emerged as a feasible treatment strategy for these high‐risk patients. However, as HF often further progresses, there is a frequent need for left ventricular assist device (LVAD) implantation in these patients. We aimed to investigate whether prior MC implantation affects the subsequent LVAD implantation and outcome. Methods and results Thirty‐seven patients with advanced HF and significant MR who underwent LVAD implantation were retrospectively analysed. Follow‐up data were collected at 1 year after LVAD implantation. Primary endpoint was all‐cause mortality. Secondary endpoint included peri‐operative parameters and clinical development depicted as New York Heart Association (NYHA) class and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level. Seventeen patients initially received a MC device (MC group), resulting in a significant reduction in MR grade. After MC, NYHA class and INTERMACS level further worsened, leading to subsequent LVAD implantation after a median time of 475 days in the MC group. At LVAD implantation, overall characteristics were comparable with those of the patients undergoing LVAD implantation without prior MC placement (no‐MC group). Procedural data revealed a higher incidence of right ventricular (RV) failure needing mechanical RV assistance and a longer need for nitric oxide ventilation in the MC group after LVAD implantation. One‐year survival was slightly better in the no‐MC group compared with the MC group [41% (n = 7/17) vs. 65% (n = 13/20); P = 0.15], albeit event‐free survival was comparable between both groups, MC and no‐MC. Conclusions LVAD implantation after MC is feasible and safe. However, in patients with advanced HF and severe MR, PMVR may only delay a needed LVAD implantation and thereby lead to poorer peri‐operative RV function and impaired outcome. Arguably, these patients might benefit from the timely management of advanced HF by the means of early LVAD implantation or heart transplantation.
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Affiliation(s)
- Michael M Kreusser
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sonja Hamed
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Andreas Weber
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Martin J Volz
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Nicolas A Geis
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Leonie Grossekettler
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Sven T Pleger
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Hugo A Katus
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philip W Raake
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
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11
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Prognostic implications of pericardial and pleural effusion in patients with cardiac amyloidosis. Clin Res Cardiol 2020; 110:532-543. [PMID: 32914241 PMCID: PMC8055634 DOI: 10.1007/s00392-020-01698-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pericardial and pleural effusion are common findings in patients with cardiac amyloidosis (CA). It is not known, whether effusions correlate with right ventricular (RV) function in these patients. Furthermore, data on the prognostic significance of pleural and pericardial effusion in CA is scarce. METHODS Patients with transthyretin (ATTR) and light chain (AL) CA were included in a clinical registry. All patients underwent transthoracic echocardiography at baseline. The presence of pericardial and pleural effusion was determined in every patient. The clinical endpoint was defined as cardiac death or heart failure hospitalization. RESULTS In total, 143 patients were analysed. Of these, 85 patients were diagnosed with ATTR and 58 patients with AL. Twenty-four patients presented with isolated pericardial effusion and 35 with isolated pleural effusion. In 19 patients, both pericardial and pleural effusion were found and in 65 patients no effusion was present at baseline. The presence of pleural effusion correlated well with poor RV function, measured by global RV free-wall strain (p = 0.007) in patients with AL, but not in ATTR. No such correlation could be found for pericardial effusion in either amyloidosis subtype. Patients with AL presenting with pleural effusion had worse outcomes compared to patients with pericardial effusion alone or no effusion at baseline. In the ATTR group, there was no difference in outcomes according to presence and type of effusion. CONCLUSION More than 50% of patients with CA presented with pleural and/or pericardial effusions. While pleural effusion was clearly associated with poor RV function in AL, we were not able to detect this association with pericardial effusion.
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12
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Cheng RK, Levy WC, Vasbinder A, Teruya S, De Los Santos J, Leedy D, Maurer MS. Diuretic Dose and NYHA Functional Class Are Independent Predictors of Mortality in Patients With Transthyretin Cardiac Amyloidosis. JACC CardioOncol 2020; 2:414-424. [PMID: 33073249 PMCID: PMC7561022 DOI: 10.1016/j.jaccao.2020.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With increasing diagnoses and available treatment options for transthyretin amyloidosis cardiomyopathy (ATTR-CM), risk stratification of ATTR-CM patients is imperative. OBJECTIVES We hypothesized that diuretic dose and New York Heart Association (NYHA) functional class are independent predictors of mortality in ATTR-CM and would be incrementally additive to existent risk scores. METHODS Consecutive ATTR-CM patients referred to a single center were identified. Adjusted Cox proportional hazards models determined the association between diuretic dose (furosemide equivalent in mg/kg) at time of diagnosis and the primary outcome of all-cause mortality. The incremental value of adding diuretic dose and NYHA functional class to existing ATTR-CM risk scores was assessed for discrimination and calibration. RESULTS 309 patients were identified, with mean age 73.2 ± 9.8 years, 84.1% male, and 66% wild type. Daily mean diuretic dose was 0.6 ± 1.0 mg/kg and significantly associated with all-cause mortality (unadjusted hazard ratio: 2.12 per 1-mg/kg increase, [95% confidence interval: 1.71 to 2.61] and fully adjusted hazard ratio: 1.43 [95% confidence interval: 1.06 to 1.93]). Testing previously published ATTR risk scores, adding diuretic dose as categories (0 mg/kg, >0 to 0.5 mg/kg, >0.5 to 1 mg/kg, and >1 to 2 mg/kg) improved the area under the curve of the Mayo risk score from 0.693 to 0.767 and the UK risk score from 0.711 to 0.787 while preserving calibration. Adding NYHA functional class further improved the area under the curve to 0.798 and 0.816, respectively. CONCLUSIONS Diuretic dose and NYHA functional class are independent predictors of mortality in ATTR-CM patients and provide incremental value to existing ATTR-CM risk scores.
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Affiliation(s)
- Richard K. Cheng
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Wayne C. Levy
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Alexi Vasbinder
- Department of Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Sergio Teruya
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffeny De Los Santos
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Douglas Leedy
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Mathew S. Maurer
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
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13
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Wintrich J, Kindermann I, Ukena C, Selejan S, Werner C, Maack C, Laufs U, Tschöpe C, Anker SD, Lam CSP, Voors AA, Böhm M. Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future. Clin Res Cardiol 2020; 109:1079-1098. [PMID: 32236720 PMCID: PMC7449942 DOI: 10.1007/s00392-020-01633-w] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/11/2020] [Indexed: 02/07/2023]
Abstract
In contrast to the wealth of proven therapies for heart failure with reduced ejection fraction (HFrEF), therapeutic efforts in the past have failed to improve outcomes in heart failure with preserved ejection fraction (HFpEF). Moreover, to this day, diagnosis of HFpEF remains controversial. However, there is growing appreciation that HFpEF represents a heterogeneous syndrome with various phenotypes and comorbidities which are hardly to differentiate solely by LVEF and might benefit from individually tailored approaches. These hypotheses are supported by the recently presented PARAGON-HF trial. Although treatment with LCZ696 did not result in a significantly lower rate of total hospitalizations for heart failure and death from cardiovascular causes among HFpEF patients, subanalyses suggest beneficial effects in female patients and those with an LVEF between 45 and 57%. In the future, prospective randomized trials should focus on dedicated, well-defined subgroups based on various information such as clinical characteristics, biomarker levels, and imaging modalities. These could clarify the role of LCZ696 in selected individuals. Furthermore, sodium-glucose cotransporter-2 inhibitors have just proven efficient in HFrEF patients and are currently also studied in large prospective clinical trials enrolling HFpEF patients. In addition, several novel disease-modifying drugs that pursue different strategies such as targeting cardiac inflammation and fibrosis have delivered preliminary optimistic results and are subject of further research. Moreover, innovative device therapies may enhance management of HFpEF, but need prospective adequately powered clinical trials to confirm safety and efficacy regarding clinical outcomes. This review highlights the past, present, and future therapeutic approaches in HFpEF.
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Affiliation(s)
- Jan Wintrich
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Germany.
| | - Ingrid Kindermann
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Christian Ukena
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Simina Selejan
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Christian Werner
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Christoph Maack
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie im Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Universitätsmedizin Berlin, Charite, Campus Rudolf Virchow Clinic (CVK), Augustenburger Platz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
- Berlin-Brandenburg Institute of Health/Center for Regenerative Therapies (BIHCRT), Berlin, Germany
| | - Stefan D Anker
- Department of Cardiology, Universitätsmedizin Berlin, Charite, Campus Rudolf Virchow Clinic (CVK), Augustenburger Platz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
- Berlin-Brandenburg Institute of Health/Center for Regenerative Therapies (BIHCRT), Berlin, Germany
| | - Carolyn S P Lam
- National Heart Centre, Singapore and Duke-National University of Singapore, Singapore, Singapore
- University Medical Centre Groningen, Groningen, The Netherlands
- The George Institute for Global Health, Sydney, Australia
| | - Adriaan A Voors
- University Medical Centre Groningen, Groningen, The Netherlands
| | - Michael Böhm
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Germany
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14
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Rivinius R, Kaya Z, Schramm R, Boeken U, Provaznik Z, Heim C, Knosalla C, Schoenrath F, Rieth A, Berchtold-Herz M, Barten MJ, Rauschning D, Mücke VT, Heyl S, Pistulli R, Grinninger C, Hagl C, Gummert JF, Warnecke G, Schulze PC, Katus HA, Kreusser MM, Raake PW. COVID-19 among heart transplant recipients in Germany: a multicenter survey. Clin Res Cardiol 2020; 109:1531-1539. [PMID: 32783099 PMCID: PMC7418884 DOI: 10.1007/s00392-020-01722-w] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023]
Abstract
Aims Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany. Methods and results A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively). Conclusion Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.
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Affiliation(s)
- Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Ziya Kaya
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - René Schramm
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Zdenek Provaznik
- Department of Cardiovascular Surgery, Regensburg University Hospital, Regensburg, Germany
| | - Christian Heim
- Department of Cardiovascular Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Rieth
- Department of Cardiology, Kerckhoff Hospital, Bad Nauheim, Germany
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Markus J Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Dominic Rauschning
- Department of Internal Medicine, Bundeswehr Central Hospital, Koblenz, Germany
| | - Victoria T Mücke
- Department of Internal Medicine I, Frankfurt University Hospital, Frankfurt, Germany
| | - Stephan Heyl
- Department of Internal Medicine III, Frankfurt University Hospital, Frankfurt, Germany
| | - Rudin Pistulli
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Münster University Hospital, Münster, Germany
| | - Carola Grinninger
- Department of Cardiac Surgery, Munich University Hospital, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Munich University Hospital, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Gregor Warnecke
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - P Christian Schulze
- Department of Cardiology, Angiology and Pneumology, Jena University Hospital, Jena, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
- German Center for Infection Research (DZIF), Partner Site Heidelberg, Heidelberg, Germany.
| | - Philip W Raake
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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Renal AA amyloidosis leading to early diagnosis and treatment of takayasu arteritis: a case report and review of the literature. Clin Res Cardiol 2020; 109:1438-1441. [PMID: 32346768 PMCID: PMC7588381 DOI: 10.1007/s00392-020-01655-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
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