1
|
Ihne-Schubert SM, Morbach C, Goetze O, Cejka V, Steinhardt MJ, Frantz S, Einsele H, Sommer C, Störk S, Schubert T, Geier A. Liver stiffness as a prognostic parameter and tool for risk stratification in advanced cardiac transthyretin amyloidosis. Clin Res Cardiol 2024:10.1007/s00392-024-02513-3. [PMID: 39164508 DOI: 10.1007/s00392-024-02513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 08/01/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND In light of increasing therapeutic options, risk stratification of advanced cardiac transthyretin amyloidosis (ATTR-CA) is gaining clinical importance to avoid ineffective treatments. Liver stiffness as a marker of hypervolemia and hepatic congestion might predict mortality in advanced ATTR-CA and allow to identify patients at highest risk. METHODS Proven ATTR-CA patients underwent repeated vibration-controlled transient elastography (VTCE) and standardized serial workup within the local amyloidosis cohort study AmyKoS. Spearman correlation analyses and Cox regressions were performed to evaluate the prognostic value. RESULTS 41 patients with ATTR-CA were included with median age of 76.6 (55.1-89.1) years, of which 90.2% were male and > 92% wild-type ATTR-CA. In total, 85 VCTE examinations were performed. Median follow-up was 43.7 (2.4-75.6) months; 26.8% of the patients died. At the first clinical evaluation, median left ventricular (LV) absolute global longitudinal strain (GLS) was 11.4 (5.2-19.0) % and median liver stiffness was 6.3 (2.4-22.9) kPa, both significantly correlated with mortality. NT-proBNP possessed statistically significant predictive power in ATTR-CA with more preserved LV function (absolute GLS ≥ 10), whereas stiffness seemed to be more discriminative for ATTR-CA with absolute GLS < 10. The use of alternative congestion surrogates such as liver vein dilation and tricuspid regurgitation peak velocity (tr-vmax) showed congruent results. CONCLUSION Liver stiffness shows prognostic value regarding all-cause mortality and allows risk stratification in advanced ATTR-CA, particularly in those with markedly impaired longitudinal LV function. These results are transferable to other congestion surrogates.
Collapse
Affiliation(s)
- Sandra Michaela Ihne-Schubert
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital of Würzburg, Würzburg, Germany.
- Department of Internal Medicine II, Hematology, University Hospital of Würzburg, Würzburg, Germany.
- Department of Internal Medicine IV, University Hospital of Gießen and Marburg, Gießen, Germany.
- CIRCLE-Centre for Innovation Research, Lund University, Lund, Sweden.
| | - Caroline Morbach
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University and University Hospital of Würzburg, Würzburg, Germany
- Department of Internal Medicine I, Cardiology, University Hospital of Würzburg, Würzburg, Germany
| | - Oliver Goetze
- Department of Internal Medicine II, Hepatology, University Hospital of Würzburg, Würzburg, Germany
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany
| | - Vladimir Cejka
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University and University Hospital of Würzburg, Würzburg, Germany
- Department of Internal Medicine I, Cardiology, University Hospital of Würzburg, Würzburg, Germany
| | - Maximilian Johannes Steinhardt
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital of Würzburg, Würzburg, Germany
- Department of Internal Medicine II, Hematology, University Hospital of Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University and University Hospital of Würzburg, Würzburg, Germany
- Department of Internal Medicine I, Cardiology, University Hospital of Würzburg, Würzburg, Germany
| | - Hermann Einsele
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital of Würzburg, Würzburg, Germany
- Department of Internal Medicine II, Hematology, University Hospital of Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital of Würzburg, Würzburg, Germany
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University and University Hospital of Würzburg, Würzburg, Germany
- Department of Internal Medicine I, Cardiology, University Hospital of Würzburg, Würzburg, Germany
| | - Torben Schubert
- CIRCLE-Centre for Innovation Research, Lund University, Lund, Sweden
- Fraunhofer Institute for Systems and Innovation Research ISI, Karlsruhe, Germany
- Department of Design Science (LTH), Lund University, Lund, Sweden
| | - Andreas Geier
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital of Würzburg, Würzburg, Germany
- Department of Internal Medicine II, Hepatology, University Hospital of Würzburg, Würzburg, Germany
| |
Collapse
|
3
|
Castaño A, Manson DK, Maurer MS, Bokhari S. Transthyretin Cardiac Amyloidosis in Older Adults: Optimizing Cardiac Imaging to the Corresponding Diagnostic and Management Goal. CURRENT CARDIOVASCULAR RISK REPORTS 2017; 11:17. [PMID: 29057029 PMCID: PMC5648026 DOI: 10.1007/s12170-017-0541-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Transthyretin cardiac amyloidosis is increasingly recognized as an important cause of heart failure in older adults. Many cardiac imaging modalities have evolved to evaluate transthyretin cardiac amyloidosis and include 2D echocardiography with tissue Doppler and speckle-strain imaging, nuclear scintigraphy, cardiac magnetic resonance imaging, and positron emission tomography. The purpose of this review is to highlight the optimal selection of advanced cardiac imaging techniques with corresponding diagnostic goals including raising suspicion, making an early diagnosis, and subtyping transthyretin cardiac amyloid, as well as management goals including assessment of ventricular impairment, prognosticating, and monitoring disease progression. Potential benefits of optimizing cardiac imaging in the elderly patient with transthyretin cardiac amyloidosis may include enhanced and earlier diagnosis and refined long-term management. RECENT FINDINGS Advances in cardiac imaging techniques are changing diagnostic and management algorithms for transthyretin cardiac amyloidosis. SUMMARY With a new era of novel therapeutics, enhanced recognition, and earlier diagnosis approaching, selecting the appropriate non-invasive cardiac imaging modality will be essential for optimal care in the elderly patient with transthyretin cardiac amyloidosis.
Collapse
Affiliation(s)
- Adam Castaño
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Center for Advanced Cardiac Care, Laboratory of Nuclear Cardiology, New York, NY 10032-3784, USA,
| | - Daniel K Manson
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Center for Advanced Cardiac Care, New York, NY 10032-3784, USA
| | - Mathew S Maurer
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Center for Advanced Cardiac Care, New York, NY 10032-3784, USA
| | - Sabahat Bokhari
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Laboratory of Nuclear Cardiology, New York, NY 10032-3784, USA
| |
Collapse
|