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Duca F, Snidat A, Binder C, Rettl R, Dachs TM, Seirer B, Camuz-Ligios L, Dusik F, Capelle CDJ, Hong Q, Agis H, Kain R, Mascherbauer J, Hengstenberg C, Badr Eslam R, Bonderman D. Hemodynamic Profiles and Their Prognostic Relevance in Cardiac Amyloidosis. J Clin Med 2020; 9:E1093. [PMID: 32290508 PMCID: PMC7230541 DOI: 10.3390/jcm9041093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open
Abstract
This study sought to characterize cardiac amyloidosis (CA) patients with respect to hemodynamic parameters and asses their prognostic impact in different CA cohorts. Intracardiac and pulmonary arterial pressures (PAPs) are among the strongest predictors of outcomes in patients with heart failure (HF). Despite that, the hemodynamic profiles of patients with CA and their relation to prognosis have rarely been investigated. Invasive hemodynamic, clinical, and laboratory assessment, as well as cardiac magnetic resonance imaging were performed in our CA cohort. A total of 61 patients, 35 (57.4%) with wild-type transthyretin amyloidosis (ATTRwt) and 26 (42.6%) with light-chain amyloidosis (AL) were enrolled. ATTRwt patients had lower N-terminal prohormone of brain natriuretic peptide values and were less frequently in New York Heart Association class ≥ III. Intracardiac and PAPs were elevated, but hemodynamic parameters did not differ between CA groups. Whereas in ATTRwt, the median mean PAP (hazard ratio (HR): 1.130, p = 0.040) and pulmonary vascular resistance (HR: 1.010, p = 0.046) were independent predictors of outcome, no hemodynamic parameter was associated with outcome in the AL group. Cardiac ATTRwt and AL patients feature elevated intracardiac and PAPs and show similar hemodynamic profiles. However, hemodynamic parameters are of greater prognostic relevance in ATTRwt, potentially providing a new therapeutic target.
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Affiliation(s)
- Franz Duca
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Amir Snidat
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Christina Binder
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - René Rettl
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Theresa-Marie Dachs
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Benjamin Seirer
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Luciana Camuz-Ligios
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Fabian Dusik
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Christophe Denis Josef Capelle
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Qin Hong
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Hermine Agis
- Department of Internal Medicine I, Department of Oncology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Renate Kain
- Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Julia Mascherbauer
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Christian Hengstenberg
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Roza Badr Eslam
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Diana Bonderman
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
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