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Ihne-Schubert SM, Goetze O, Gerstendörfer F, Sahiti F, Schade I, Papagianni A, Morbach C, Frantz S, Einsele H, Knop S, Sommer C, Müllhaupt B, Schubert T, Störk S, Geier A. Cardio-Hepatic Interaction in Cardiac Amyloidosis. J Clin Med 2024; 13:1440. [PMID: 38592299 PMCID: PMC10932330 DOI: 10.3390/jcm13051440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/27/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Congestion is associated with poor prognosis in cardiac amyloidosis (CA). The cardio-hepatic interaction and the prognostic impact of secondary liver affection by cardiac congestion in CA are poorly understood and require further characterisation. Methods: Participants of the amyloidosis cohort study AmyKoS at the Interdisciplinary Amyloidosis Centre of Northern Bavaria with proven transthyretin (ATTR-CA) and light chain CA (AL-CA) underwent serial work-up including laboratory tests, echocardiography, and in-depth hepatic assessment by vibration-controlled transient elastography (VCTE) and 13C-methacetin breath test. Results: In total, 74 patients with AL-CA (n = 17), ATTR-CA (n = 26) and the controls (n = 31) were analysed. ATTR-CA patients showed decreased microsomal liver function expressed by maximal percentage of dose rate (PDRpeak) related to hepatic congestion. Reduced PDRpeak in AL-CA could result from altered pharmacokinetics due to changed hepatic blood flow. Liver stiffness as a combined surrogate of chronic liver damage and congestion was identified as a predictor of all-cause mortality. Statistical modelling of the cardio-hepatic interaction revealed septum thickness, NT-proBNP and PDRpeak as predictors of liver stiffness in both CA subtypes; dilatation of liver veins and the fibrosis score FIB-4 were only significant for ATTR-CA. Conclusions: Non-invasive methods allow us to characterise CA-associated hepatic pathophysiology. Liver stiffness might be promising for risk stratification in CA.
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Affiliation(s)
- Sandra Michaela Ihne-Schubert
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine II, Hematology, University Hospital Würzburg, 97080 Würzburg, Germany
- CIRCLE—Centre for Innovation Research, Lund University, 22100 Lund, Sweden
- Department of Internal Medicine IV, University Hospital Gießen and Marburg, 35392 Gießen, Germany
| | - Oliver Goetze
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine II, Hepatology, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany
| | - Felix Gerstendörfer
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine II, Hematology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Floran Sahiti
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Ina Schade
- Department of Thoracic Surgery and Thoracic Endoscopy, Helios Klinikum Erfurt, 99089 Erfurt, Germany
| | - Aikaterini Papagianni
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Caroline Morbach
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Stefan Frantz
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Hermann Einsele
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine II, Hematology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Stefan Knop
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine II, Hematology, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine V, Hospital Nürnberg Nord, 90419 Nürnberg, Germany
| | - Claudia Sommer
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Beat Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Torben Schubert
- CIRCLE—Centre for Innovation Research, Lund University, 22100 Lund, Sweden
- Fraunhofer Institute for Systems and Innovation Research ISI, 76139 Karlsruhe, Germany
| | - Stefan Störk
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine I, Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Andreas Geier
- Interdisciplinary Amyloidosis Center of Northern Bavaria, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Internal Medicine II, Hepatology, University Hospital Würzburg, 97080 Würzburg, Germany
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