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Ney S, Gertz RJ, Pennig L, Nies RJ, Holtick U, Völker LA, Wunderlich G, Seuthe K, Hohmann C, Metze C, Nähle CP, von Stein J, Brüwer M, ten Freyhaus H, Pfister R. Multiparametric Monitoring of Disease Progression in Contemporary Patients with Wild-Type Transthyretin Amyloid Cardiomyopathy Initiating Tafamidis Treatment. J Clin Med 2024; 13:284. [PMID: 38202291 PMCID: PMC10779991 DOI: 10.3390/jcm13010284] [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: 11/24/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Recently, a disease modifying therapy has become available for transthyretin amyloid cardiomyopathy (ATTR-CM). A validated monitoring concept of treatment is lacking, but a current expert consensus recommends three clinical domains (clinical, biomarker and ECG/imaging) assessed by several measurable features to define disease progression. METHODS We retrospectively analyzed data of wild-type ATTR-CM patients initiating tafamidis therapy assessed within our local routine protocol at baseline and 6-months follow-up with respect to the frequency of values beyond the proposed thresholds defining disease progression. Additionally, associations of cardiac magnetic resonance (CMR) tomography with clinical domains were examined within a subgroup. RESULTS Sixty-two ATTR-CM patients were included (88.7% male, mean age 79 years). In total, 16.1% of patients had progress in the clinical and functional domain, 33.9% in the biomarker domain and 43.5% in the imaging/electrocardiography (ECG) domain, with the latter driven by deterioration of the diastolic dysfunction grade and global longitudinal strain. In total, 35.5% of patients showed progress in none, 35.5% in one, 29.0% in two and no patient in three domains, the latter indicating overall disease progression. A subgroup analysis of twenty-two patients with available baseline and follow-up CMR data revealed an increase in CMR-based extracellular volume by more than 5% in 18.2% of patients, with no significant correlation with progress in one of the clinical domains. CONCLUSIONS We provide first frequency estimates of the markers of disease progression according to a recent expert consensus statement, which might help refine the multiparametric monitoring concept in patients with ATTR-CM.
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Affiliation(s)
- Svenja Ney
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Roman Johannes Gertz
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.G.); (L.P.); (C.P.N.)
| | - Lenhard Pennig
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.G.); (L.P.); (C.P.N.)
| | - Richard J. Nies
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Udo Holtick
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Linus A. Völker
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- Cologne Cluster of Excellence on Cellular Stress Responses in Ageing-Associated Diseases, 50923 Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology and Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Katharina Seuthe
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Christopher Hohmann
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Clemens Metze
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Claas Philip Nähle
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.G.); (L.P.); (C.P.N.)
- Radiologische Allianz Hamburg, 20357 Hamburg, Germany
| | - Jennifer von Stein
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Monique Brüwer
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Henrik ten Freyhaus
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Roman Pfister
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
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