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Albenque G, Bézard M, Kharoubi M, Odouard S, Lunati A, Poullot E, Zaroui A, Teiger E, Hittinger L, Audard V, El Karoui K, Funalot B, Fanen P, Damy T, Oghina S. Comparison of cardiac involvement, extracardiac manifestations and outcomes between homozygote and heterozygote transthyretin p.Val142Ile (V122I) variant in patients with hereditary transthyretin amyloidosis: a cohort study. Amyloid 2023; 30:407-415. [PMID: 37377439 DOI: 10.1080/13506129.2023.2227322] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Hereditary transthyretin (ATTRv) p.Val142Ile (V122I) mutation is the most common inherited cause of cardiac amyloidosis and little is known about the phenotype and outcome of the rare homozygotic genotype. This study aimed to compare phenotypic characteristics and outcomes between heterozygous and homozygous patients with ATTRv V122I amyloidosis. MATERIAL AND METHODS This monocentric, observational, retrospective study conducted at the French National Referral Centre for Cardiac Amyloidosis (Henri Mondor Hospital, Créteil), described clinical, electrocardiographic, cardiac imaging features and prognostic data for patients with ATTRv V122I amyloidosis. RESULTS Among 185 ATTRv V122I patients identified, 161 were heterozygous and 24 were homozygous. The homozygous frequency was 13%. Onset occured significantly earlier in the homozygotes compared to heterozygotes with earlier median age at diagnosis (67[63-71] years vs 76[70-79] years, p < .001), age at first cardiac symptom (66[61-71] years vs 74[68-78] years, p < .001) and age at first extracardiac symptom (59[52-70] years vs 69[62-75] years, p = .003). Homozygous ATTRv V122I was also associated with greater disease burden with earlier events (death, transplant or hospitalisation for acute heart failure) compared with heterozygotes (71[67-74] vs 78[76-79] years, p = .018). CONCLUSION This rare, homozygous V122I cohort confirmed the earlier age of onset, death and cardiac events in this population.
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Affiliation(s)
- Grégoire Albenque
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Mélanie Bézard
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Mounira Kharoubi
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Shirley Odouard
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Ariane Lunati
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Elsa Poullot
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
- Department of Pathology, Henri Mondor Teaching Hospital, APHP, Creteil, France
| | - Amira Zaroui
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Emmanuel Teiger
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Luc Hittinger
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Vincent Audard
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
- Department of Nephrology and Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Henri Mondor teaching Hospital, APHP, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Khalil El Karoui
- Department of Nephrology, Tenon Teaching Hospital, APHP, Paris, France
| | - Benoît Funalot
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
- Department of Genetics, Henri Mondor Teaching Hospital, APHP, Creteil, France
| | - Pascale Fanen
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
- Department of Genetics, Henri Mondor Teaching Hospital, APHP, Creteil, France
| | - Thibaud Damy
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Silvia Oghina
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
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Kharoubi M, Bézard M, Broussier A, Galat A, Gounot R, Poullot E, Molinier-Frenkel V, Fanen P, Funalot B, Itti E, Lemonnier F, Sing Chadha GD, Guendouz S, Mallet S, Zaroui A, Audard V, Audureau E, Le Corvoisier P, Hittinger L, Planté Bordeneuve V, Lefaucheur JP, Amiot A, Bequignon E, Bartier S, Leroy V, Teiger E, Oghina S, Damy T. Amylo-AFFECT-QOL, a self-reported questionnaire to assess health-related quality of life and to determine the prognosis in cardiac amyloidosis. Front Cardiovasc Med 2023; 10:1124660. [PMID: 36998975 PMCID: PMC10043221 DOI: 10.3389/fcvm.2023.1124660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/10/2023] [Indexed: 03/15/2023] Open
Abstract
Background and aimsSelf-reported questionnaires are useful for estimating the health-related quality of life (HR-QoL), impact of interventions, and prognosis. To our knowledge, no HR-QoL questionnaire has been developed for cardiac amyloidosis (CA). This study aimed to validate Amylo-AFFECT-QOL questionnaire to assess HR-QoL and its prognostic value in CA.MethodsA self-reported questionnaire, “Amylo-AFFECT” had been designed and validated for CA symptoms evaluation and screening by physicians. It was adapted here to assess HR-QoL (Amylo-AFFECT-QOL) and its prognostic value in CA. To validate the theoretical model, internal consistency and convergent validity were assessed, particularly correlations between Amylo-AFFECT-QOL and the HR-QoL Minnesota Living Heart Failure (MLHF) questionnaire.ResultsAmylo-AFFECT-QOL was completed by 515 patients, 425 of whom (82.5%) had CA. Wild-type and hereditary transthyretin amyloidosis (ATTRwt and ATTRv) and immunoglobulin light-chain amyloidosis (AL) were diagnosed in 47.8, 14.7, and 18.8% of cases, respectively. The best HR-QoL evaluation was obtained with five dimensions: “Heart failure,” “Vascular dysautonomia,” “Neuropathy,” “Ear, gastrointestinal, and urinary dysautonomia,” and “Skin or mucosal involvement.” The global Amylo-AFFECT-QOL and MLHF scores showed significant positive correlations (rs = 0.72, p < 0.05). Patients with a final diagnosis of CA had a global Amylo-AFFECT-QOL score significantly higher than the control group composed by patients with other diagnoses (22.2 ± 13.6 vs. 16.2 ± 13.8, respectively, p-value < 0.01). According to the Amylo-AFFECT-QOL global results, ATTRv patients’ QoL was more affected than AL patients’ QoL or ATTRwt patients’ QoL. Patients with a higher HR-QoL score had a greater risk of death or heart transplant after 1 year of follow-up (log-rank < 0.01).ConclusionAmylo-AFFECT-QOL demonstrates good psychometric properties and is useful for quantifying HR-QoL and estimating CA prognosis. Its use may help to improve overall management of patients with CA.
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Affiliation(s)
- Mounira Kharoubi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
- *Correspondence: Mounira Kharoubi,
| | - Mélanie Bézard
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Amaury Broussier
- Université Paris-Est Créteil (UPEC), Creteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hopitaux Henri-Mondor/Emile Roux, Department of Geriatrics, Limeil-Brévannes, France
| | - Arnault Galat
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Romain Gounot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Lymphoid Malignancies, Henri Mondor University Hospital, Créteil, France
| | - Elsa Poullot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Pathology, Henri Mondor University Hospital, Créteil, France
| | - Valérie Molinier-Frenkel
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Lymphoid Malignancies, Henri Mondor University Hospital, Créteil, France
- University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Pascale Fanen
- University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Département de Génétique, Hôpital Universitaire Henri Mondor, Créteil, France
| | - Benoit Funalot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Département de Génétique, Hôpital Universitaire Henri Mondor, Créteil, France
| | - Emmanuel Itti
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Nuclear Medicine, Henri Mondor University Hospital, Créteil, France
| | - François Lemonnier
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
| | - Gagan Deep Sing Chadha
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Soulef Guendouz
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Sophie Mallet
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Amira Zaroui
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Vincent Audard
- University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology and Renal Transplantation Department, Henri Mondor Hospital University, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire « Innovative Therapy for Immune Disorders », Créteil, France
| | - Etienne Audureau
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Department, Henri Mondor University Hospital, Créteil, France
| | - Philippe Le Corvoisier
- INSERM Clinical Investigation Centre 1430, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Luc Hittinger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Violaine Planté Bordeneuve
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Neurology, Henri Mondor University Hospital, Créteil, France
| | - Jean-Pascal Lefaucheur
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Neurophysiology, Henri Mondor University Hospital, Créteil, France
| | - Aurélien Amiot
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hepato Gastro Enterology Department, Henri Mondor University Hospital, Créteil, France
| | - Emilie Bequignon
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Otolaryngology, Henri Mondor University Hospital, Créteil, France
| | - Sophie Bartier
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Otolaryngology, Henri Mondor University Hospital, Créteil, France
| | - Vincent Leroy
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hepato Gastro Enterology Department, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Teiger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Silvia Oghina
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
- INSERM Clinical Investigation Centre 1430, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
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Kharoubi M, Bézard M, Broussier A, Galat A, Le Bras F, Fanen P, Funalot B, Deux JF, Lemonnier F, Guendouz S, Mallet S, Zaroui A, Itti E, Audard V, Audureau E, Hittinger L, Teiger E, Oghina S, Damy T. Validation of Amylo-AFFECT, a self-reported questionnaire to assess health-related quality of life and to determine the prognosis in cardiac amyloidosis. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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4
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Bézard M, Kharoubi M, Galat A, Le Bras F, Poullot E, Molinier-Frenkel V, Fanen P, Funalot B, Moktefi A, Abulizi M, Deux JF, Lemonnier F, Guendouz S, Chalard C, Zaroui A, Itti E, Hittinger L, Teiger E, Oghina S, Damy T. Real-Life Evaluation of an Algorithm for the Diagnosis of Cardiac Amyloidosis. Mayo Clin Proc 2023; 98:48-59. [PMID: 36464537 DOI: 10.1016/j.mayocp.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To evaluate the real-life use of a modified Gillmore algorithm with a "one-stop-shop" approach, bone scintigraphy (BS), a monoclonal gammopathy test (GT), a salivary gland biopsy (SGB), and genetic testing performed at the same time for the diagnosis of cardiac amyloidosis at the French National Reference Centre for Cardiac Amyloidosis (Henri Mondor Hospital, Créteil, France). METHODS This retrospective cohort study included a total of 1222 patients with suspected amyloidosis who underwent BS and GT between June 2008 and May 2019. RESULTS Of 1222 patients, 349 had no cardiac uptake on BS and negative GT (BS-/GT-), 276 were BS-/GT positive (GT+), 420 patients were BS+/GT-, and 177 were BS+/GT+. Our one-stop-shop check-up enabled us to diagnose 892 (72.9%) patients; 330 (27.0%) patients required additional examinations, such as mass spectrometry and/or a cardiac biopsy. This subset notably included 112 patients with amyloid light chain amyloidosis. More than 64% of the patients with transthyretin amyloidosis or another type of amyloidosis were diagnosed during the one-stop shop visit. Sensitivity and specificity of BS for transthyretin amyloidosis diagnosis was 99% and 96%, respectively. For amyloid light chain diagnosis, sensitivity and specificity were 100% and 76%, respectively, for GT and 54% and 100%, respectively, for SGB. Of 910 transthyretin genetic tests, 205 (17%) detected mutations. CONCLUSION The results of our real-life cohort study confirmed the ability of a one-stop-shop approach with a modified Gillmore algorithm to diagnose cardiac amyloidosis and the interest of simultaneous testing for earlier diagnosis. The SGB has diagnostic value because it is easy, quick, and less invasive than a cardiac biopsy.
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Affiliation(s)
- Mélanie Bézard
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France.
| | - Mounira Kharoubi
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Arnault Galat
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Fabien Le Bras
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Lymphoid Malignancies, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Elsa Poullot
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Valérie Molinier-Frenkel
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Pascale Fanen
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Genetics Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Genetics Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Anissa Moktefi
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Mukedaisi Abulizi
- Nuclear Medicine Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Jean-François Deux
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Radiology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - François Lemonnier
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Lymphoid Malignancies, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Soulef Guendouz
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Coraline Chalard
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Amira Zaroui
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Itti
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Nuclear Medicine Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Luc Hittinger
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Teiger
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Silvia Oghina
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Clinical Investigation Centre, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
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5
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Albenque G, Bézard M, Kharoubi M, Odouard S, Lunati A, Poullot E, Zaroui A, Teiger E, Hittinger L, El Karoui K, Audard V, Funalot B, Fanen P, Damy T, Oghina S. Homozygote and heterozygote transthyretin p.Val142Ile (V122I) genetic variant: Comparison of cardiac involvement, extracardiac manifestations and outcomes. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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6
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Abroud H, Beldi‐Ferchiou A, Audard V, Lemonnier F, Le Bras F, Belhadj K, Moktefi A, Poullot E, El Karoui K, Dupuis J, Maarek A, Roulin L, Delfau‐Larue M, Oghina S, Kharoubi M, Bézard M, Zaroui A, Damy T, Molinier‐Frenkel V. Evaluation of a new ELISA assay for monoclonal free‐light chain detection in patients with cardiac amyloidosis. eJHaem 2022; 3:828-837. [PMID: 36051065 PMCID: PMC9421952 DOI: 10.1002/jha2.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/27/2022]
Abstract
The causal protein of amyloid light‐chain (AL) amyloidosis is a monoclonal immunoglobulin free light chain (mFLC), which must be quantified in the serum for patient diagnosis and monitoring. Several manufacturers commercialize immunoassays that quantify total kappa (κ) and lambda (λ) FLC, but results can differ greatly between these tests. Here, we compared a recently developed enzyme‐linked immunosorbent assay (ELISA) (Sebia) with N‐Latex immunonephelometry (Siemens) in 96 patients diagnosed with AL amyloidosis (histologically confirmed) and 48 non‐AL patients sent to our referral center for suspicion of cardiac amyloidosis. ELISA free‐light chain difference (dFLC) were lower than N‐Latex values, and agreement between methods was reduced in the case of involved λ FLC. Diagnosis sensitivity and specificity were >85% with both assays. A receiver operating characteristic analysis indicated that ELISA performances could be improved by using a higher value for the lower limit of the κ/λ ratio. We also assessed Freelite (The Binding Site) in a subgroup of these same AL patients, including 18 cases with normal κ/λ ratio by at least one assay. Only two patients had normal κ/λ ratio with all three assays. Overall, ELISA demonstrated slightly lower sensitivity than N‐Latex but may be an alternative to nephelometry/turbidimetry in certain difficult cases.
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Affiliation(s)
- Hajer Abroud
- Département d'Hématologie‐Immunologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Asma Beldi‐Ferchiou
- Département d'Hématologie‐Immunologie AP‐HP, Hopital Henri Mondor Creteil France
- INSERM IMRB Univ Paris Est Creteil Creteil France
| | - Vincent Audard
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Service de Néphrologie et Transplantation AP‐HP, Hopital Henri Mondor Creteil France
| | - François Lemonnier
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Fabien Le Bras
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Karim Belhadj
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Anissa Moktefi
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Pathologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Elsa Poullot
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Pathologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Khalil El Karoui
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Service de Néphrologie et Transplantation AP‐HP, Hopital Henri Mondor Creteil France
| | - Jehan Dupuis
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Alizée Maarek
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Louise Roulin
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Marie‐Hélène Delfau‐Larue
- Département d'Hématologie‐Immunologie AP‐HP, Hopital Henri Mondor Creteil France
- INSERM IMRB Univ Paris Est Creteil Creteil France
| | - Silvia Oghina
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Mounira Kharoubi
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Mélanie Bézard
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Amira Zaroui
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Thibaud Damy
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
- INSERM, IMRB, CEPiaA Univ Paris Est Creteil Creteil France
| | - Valérie Molinier‐Frenkel
- Département d'Hématologie‐Immunologie AP‐HP, Hopital Henri Mondor Creteil France
- INSERM IMRB Univ Paris Est Creteil Creteil France
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
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7
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Kharoubi M, Bodez D, Bézard M, Zaroui A, Galat A, Guendouz S, Gendre T, Hittinger L, Attias D, Mohty D, Bergoend E, Itti E, Lebras F, Hamon D, Poullot E, Molinier-Frenkel V, Lellouche N, Deux JF, Funalot B, Fannen P, Oghina S, Arrouasse R, Lecorvoisier P, Souvannanorath S, Amiot A, Teiger E, Bougouin W, Damy T. Describing mode of death in three major cardiac amyloidosis subtypes to improve management and survival. Amyloid 2022; 29:79-91. [PMID: 35114877 DOI: 10.1080/13506129.2021.2013193] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The three main cardiac amyloidosis (CA) types have different progression and prognosis. Little is known about the mode of death (MOD) which is commonly attributed to cardiovascular causes in CA. Improving MOD's knowledge could allow to adapt patient care. OBJECTIVE This retrospective study describes the MOD that occurred during long-term follow-up in CA patients in light-chain (AL), transthyretin hereditary (ATTRv) or wild-type (ATTRwt). MATERIAL AND METHODS Patients referred to and cared for, at the French referral centre for CA, Henri Mondor Hospital, Créteil between 2010 and 2016 were included. Clinical information surrounding patient deaths were investigated and centrally evaluated by two blinded clinical committees which classified MOD as cardiovascular, non-cardiovascular or unknown and sub-classified it depending on its subtype. RESULTS From the 566 patients included, 187 had AL, 206 ATTRv and 173 ATTRwt. During the 864 patient-year follow-up, 160 (28%) deaths occurred, with median survival time of 17.3 months (interquartile range 5.1-35.4). The most frequent MOD was cardiovascular (64%) of which worsening heart failure occurred most frequently and for which, 69% were of AL subtype, 79% ATTRv and 76% ATTRwt. Sudden death also occurred more frequently in AL subtype accounting for 29% of AL deaths. Non-cardiovascular MOD occurred in 26% of patients overall. Among these, infection was the most common non-cardiovascular MOD in any type of CA (80%). CONCLUSIONS Mortality is high during natural course of CA and differs between subtypes. The main MOD were worsening heart failure, sudden death and infection, opening room to optimise management.
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Affiliation(s)
- Mounira Kharoubi
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Diane Bodez
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France.,Centre Cardiologique du Nord, Saint Denis, France
| | - Mélanie Bézard
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Amira Zaroui
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Arnault Galat
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Soulef Guendouz
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Thierry Gendre
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Neurology, Henri Mondor University Hospital, Creteil, France
| | - Luc Hittinger
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - David Attias
- Centre Cardiologique du Nord, Saint Denis, France
| | - Dania Mohty
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,AL Amyloidosis Referral Center, Dupuytren University Hospital, Limoges, France
| | - Eric Bergoend
- AP-HP, Department of Cardiac Surgery, Henri Mondor University Hospital, Creteil, France
| | - Emmanuel Itti
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Nuclear Medicine, Henri Mondor University Hospital, Creteil, France
| | - Fabien Lebras
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Lymphoid Malignancy Unit, Henri Mondor University Hospital, Creteil, France
| | - David Hamon
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Elsa Poullot
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Biology-Pathology, Henri Mondor Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Valérie Molinier-Frenkel
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Biology-Pathology, Henri Mondor Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,AP-HP, Department of Immunobiology, Henri Mondor University Hospital, Créteil, France
| | - Nicolas Lellouche
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Jean-François Deux
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Radiology, Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Genetic, Henri Mondor Teaching Hospital, Créteil, France
| | - Pascale Fannen
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Genetic, Henri Mondor Teaching Hospital, Créteil, France
| | - Silvia Oghina
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Raphael Arrouasse
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,Inserm, Clinical Investigations Center 1430, AP-HP, DMU Saphire, Henri Mondor University Hospital, Creteil, France
| | - Philippe Lecorvoisier
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,Inserm, Clinical Investigations Center 1430, AP-HP, DMU Saphire, Henri Mondor University Hospital, Creteil, France
| | - Sarah Souvannanorath
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Referral Center for Neuromuscular Disease Department, Henri Mondor University Hospital, Créteil, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor University Hospital, AP-HP, EA7375, University Paris-Est Creteil, Creteil, France
| | - Emmanuel Teiger
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Wulfran Bougouin
- AP-HP, Centre de Recherche Cardiovasculaire de Paris (PARCC), INSERM U970, Centre d'Expertise Mort Subite (CEMS), Paris Descartes University, Paris, France.,Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Thibaud Damy
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France.,Inserm, Clinical Investigations Center 1430, AP-HP, DMU Saphire, Henri Mondor University Hospital, Creteil, France
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8
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Jobbé‐Duval A, Bézard M, Moutereau S, Kharoubi M, Oghina S, Zaroui A, Galat A, Chalard C, Hugon‐Vallet E, Lemonnier F, Eyharts D, Poulot E, Fanen P, Funalot B, Molinier‐Frenkel V, Audard V, Hittinger L, Delbarre MA, Teiger E, Damy T. Prevalence and determinants of iron deficiency in cardiac amyloidosis. ESC Heart Fail 2022; 9:1314-1327. [PMID: 35128833 PMCID: PMC8934992 DOI: 10.1002/ehf2.13818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/23/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022] Open
Abstract
Aims Iron deficiency (ID) is common in patient with chronic heart failure (HF) and has been widely studied. In contrast, data concerning ID in cardiac amyloidosis (CA) are limited. Amyloidosis is a severe and fatal systemic disease, characterized by an accumulation of amyloid fibrils in various tissues/organs, including nerves, kidneys, gastrointestinal tract, and heart. Amyloid deposits in the heart eventually cause HF. The main subtypes of CA are light chain (AL), hereditary transthyretin (ATTRv), and wild‐type transthyretin (ATTRwt). We performed this study to determine the prevalence, clinical outcome (all‐cause mortality), and determinants of ID among the three main subtypes of CA. Methods and results Iron deficiency status were analysed in 816 CA patients enrolled at the French Referral Centre for Cardiac Amyloidosis: 271 (33%) had AL, 164 (20%) ATTRv, and 381 (47%) ATTRwt. ID affected 49% of CA patients, 45% with AL, 58% with ATTRv, and 48% with ATTRwt. We identified ATTR status (ATTRv P = 0.003, ATTRwt P = 0.037), diabetes (P = 0.003), aspirin treatment (P = 0.009), haemoglobin levels (P = 0.006), and altered global longitudinal strain (P = 0.02) as independent ID determinants. There is no difference in all‐cause mortality considering ID status. Conclusions Iron deficiency is common in patients with CA, irrespective of the subtype. Patients seem more likely to have ID if diagnosed with ATTR, if diabetic, and/or treated with aspirin. In CA, the benefit of intravenous iron therapy, for ID, on morbidity and mortality needs further study.
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Affiliation(s)
- Antoine Jobbé‐Duval
- Heart Failure and Transplant Department ‘Louis Pradel’ Cardiologic Hospital, Hospices Civils de Lyon Lyon France
| | - Mélanie Bézard
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Stéphane Moutereau
- Department of Biochemistry Henri Mondor Teaching Hospital, APHP Creteil France
| | - Mounira Kharoubi
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Silvia Oghina
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Amira Zaroui
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Arnault Galat
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Coraline Chalard
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Elisabeth Hugon‐Vallet
- Heart Failure and Transplant Department ‘Louis Pradel’ Cardiologic Hospital, Hospices Civils de Lyon Lyon France
| | - Francois Lemonnier
- Department of Haematology Henri Mondor Teaching Hospital, APHP Creteil France
| | - Damien Eyharts
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Elsa Poulot
- Department of Pathology Henri Mondor Teaching Hospital, APHP Creteil France
| | - Pascale Fanen
- Department of Genetics Henri Mondor Teaching Hospital, APHP Creteil France
| | - Benoit Funalot
- Department of Genetics Henri Mondor Teaching Hospital, APHP Creteil France
| | | | - Vincent Audard
- Department of Nephrology Henri Mondor Teaching Hospital, APHP Creteil France
| | - Luc Hittinger
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Marc Antoine Delbarre
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Emmanuel Teiger
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Thibaud Damy
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
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Bonnefous L, Kharoubi M, Bézard M, Oghina S, Le Bras F, Poullot E, Molinier-Frenkel V, Fanen P, Deux JF, Audard V, Itti E, Damy T, Audureau E. Assessing Cardiac Amyloidosis Subtypes by Unsupervised Phenotype Clustering Analysis. J Am Coll Cardiol 2021; 78:2177-2192. [PMID: 34823661 DOI: 10.1016/j.jacc.2021.09.858] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cardiac amyloidosis (CA) is a set of amyloid diseases with usually predominant cardiac symptoms, including light-chain amyloidosis (AL), hereditary variant transthyretin amyloidosis (ATTRv), and wild-type transthyretin amyloidosis (ATTRwt). CA are characterized by high heterogeneity in phenotypes leading to diagnosis delay and worsened outcomes. OBJECTIVES The authors used clustering analysis to identify typical clinical profiles in a large population of patients with suspected CA. METHODS Data were collected from the French Referral Center for Cardiac Amyloidosis database (Hôpital Henri Mondor, Créteil), including 1,394 patients with suspected CA between 2010 and 2018: 345 (25%) had a diagnosis of AL, 263 (19%) ATTRv, 402 (29%) ATTRwt, and 384 (28%) no amyloidosis. Based on comprehensive clinicobiological phenotyping, unsupervised clustering analyses were performed by artificial neural network-based self-organizing maps to identify patient profiles (clusters) with similar characteristics, independent of the final diagnosis and prognosis. RESULTS Mean age and left ventricular ejection fraction were 72 ± 13 years and 52% ± 13%, respectively. The authors identified 7 clusters of patients with contrasting profiles and prognosis. AL patients were distinctively located within a typical cluster; ATTRv patients were distributed across 4 clusters with varying clinical presentations, 1 of which overlapped with patients without amyloidosis; interestingly, ATTRwt patients spread across 3 distinct clusters with contrasting risk factors, biological profiles, and prognosis. CONCLUSIONS Clustering analysis identified 7 clinical profiles with varying characteristics, prognosis, and associations with diagnosis. Especially in patients with ATTRwt, these results suggest key areas to improve amyloidosis diagnosis and stratify prognosis depending on associated risk factors.
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Affiliation(s)
- Louis Bonnefous
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Department, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France
| | - Mounira Kharoubi
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France
| | - Mélanie Bézard
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France
| | - Silvia Oghina
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France
| | - Fabien Le Bras
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Hematology Department, Henri Mondor University Hospital, Créteil, France
| | - Elsa Poullot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France
| | - Valérie Molinier-Frenkel
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France
| | - Pascale Fanen
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Genetics Department, Henri Mondor University Hospital, Créteil, France
| | - Jean-François Deux
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Radiology Department, Henri Mondor University Hospital, Créteil, France
| | - Vincent Audard
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology Department, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Itti
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Nuclear Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Investigation Center 1430, Henri Mondor University Hospital, Créteil, France
| | - Etienne Audureau
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Department, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France.
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10
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Kharoubi M, Bézard M, Galat A, Le Bras F, Poullot E, Molinier-Frenkel V, Fanen P, Funalot B, Moktefi A, Lefaucheur JP, Abulizi M, Deux JF, Lemonnier F, Guendouz S, Chalard C, Zaroui A, Audard V, Bequignon E, Bodez D, Itti E, Hittinger L, Audureau E, Teiger E, Oghina S, Damy T. History of extracardiac/cardiac events in cardiac amyloidosis: prevalence and time from initial onset to diagnosis. ESC Heart Fail 2021; 8:5501-5512. [PMID: 34714605 PMCID: PMC8712826 DOI: 10.1002/ehf2.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 11/09/2022] Open
Abstract
Aims Cardiac amyloidosis (CA) has a poor prognosis which is aggravated by diagnostic delay. Amyloidosis extracardiac and cardiac events (AECE and ACE) may help improve CA diagnosis and typing. The aim of this study was to compare AECE and ACE between different CA types and assess their relationship with survival. Methods and results This retrospective cohort study conducted in France from June 2008 to May 2019, at the Henry Mondor Hospital. This cohort included 983 patients with CA. Mean age at inclusion was 73.1 ± 11.4 years, 726 (75.1%) were male and the mean body mass index was 24.5 ± 4.1 kg/m2. Among them, 321 had immunoglobulin light chain (AL) amyloidosis, 434 had wild‐type transthyretin (ATTRwt), and 212 had hereditary transthyretin (ATTRv). The first AECE and/or ACE occurred at a mean age of 63 ± 11 years for AL and ATTRv, and 70 ± 12 years for ATTRwt (P < 0.01). The median (Q1–Q3) delay between declaration of the first events and diagnosis varied from 11.1 (5.9; 34.8) months for AL to 92.2 (39.0; 174.7) months for ATTRwt (P < 0.01). The nature of the onset of AECE or ACE varied based on amyloidosis type, heart failure symptoms for AL (26%) and integumentary symptoms for ATTRv with cardiologic or mixed phenotype (39%) and ATTRwt (42%). In AL and ATTRwt, a short delay between the onset of the first AECE or ACE and diagnosis was associated with reduced survival rate (log‐rank test P‐value <0.01). Conclusions This study highlights the impact of amyloidosis type and evolution on diagnostic delay and on prognosis. Physicians must be aware and vigilant in front of extracardiac and cardiac events to considerably improve early diagnosis of amyloidosis.
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Affiliation(s)
- Mounira Kharoubi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Mélanie Bézard
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Arnault Galat
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Fabien Le Bras
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Lymphoid Malignancies, Henri Mondor University Hospital, Créteil, France
| | - Elsa Poullot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France
| | - Valérie Molinier-Frenkel
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France
| | - Pascale Fanen
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Genetics Department, Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Genetics Department, Henri Mondor University Hospital, Créteil, France
| | - Anissa Moktefi
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France
| | - Jean-Pascal Lefaucheur
- EA4391, ENT, Université Paris Est Créteil, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Neurophysiology Unit, Henri Mondor University Hospital, Créteil, France
| | - Mukedaisi Abulizi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Nuclear Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Jean-François Deux
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Radiology Department, Henri Mondor University Hospital, Créteil, France
| | - François Lemonnier
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Lymphoid Malignancies, Henri Mondor University Hospital, Créteil, France
| | - Soulef Guendouz
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Coraline Chalard
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Amira Zaroui
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Vincent Audard
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology and Renal Transplantation Department, Henri Mondor University Hospital, Créteil, France
| | - Emilie Bequignon
- AP-HP (Assistance Publique-Hôpitaux de Paris), Otorhinolaryngologic Department, Henri Mondor University Hospital, Créteil, France
| | - Diane Bodez
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,Cardiology Outpatients Unit, Centre Cardiologique du Nord, Paris, France
| | - Emmanuel Itti
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Nuclear Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Luc Hittinger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Etienne Audureau
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Departement, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Teiger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Silvia Oghina
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Investigation Center 1430, Henri Mondor University Hospital, Créteil, France
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11
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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: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Bézard M, Oghina S, Vitiello D, Kharoubi M, Kordeli E, Galat A, Zaroui A, Guendouz S, Gilles F, Shourick J, Hamon D, Audard V, Teiger E, Poullot E, Molinier-Frenkel V, Lemonnier F, Agbulut O, Le Bras F, Damy T. Dexamethasone is associated with early deaths in light chain amyloidosis patients with severe cardiac involvement. PLoS One 2021; 16:e0257189. [PMID: 34525116 PMCID: PMC8443042 DOI: 10.1371/journal.pone.0257189] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cardiac light chain amyloidosis (AL-CA) patients often die within three months of starting chemotherapy. Chemotherapy for non-immunoglobulin M gammopathy with AL-CA frequently includes bortezomib (Bor), cyclophosphamide (Cy), and dexamethasone (D). We previously reported that NT-ProBNP levels can double within 24h of dexamethasone administration, suggesting a deleterious impact on cardiac function. In this study, we evaluate the role of dexamethasone in early cardiovascular mortality during treatment. Methods and findings We retrospectively assessed 100 de novo cardiac AL patients (62% male, mean age 68 years) treated at our institute between 2009 and 2018 following three chemotherapy regimens: CyBorDComb (all initiated on day 1; 34 patients), DCyBorSeq (D, day 1; Cy, day 8; Bor, day 15; 17 patients), and CyBorDSeq (Cy, day 1; Bor, day 8; D, day 15; 49 patients). The primary endpoint was cardiovascular mortality and cardiac transplantation at days 22 and 455. At day 22, mortality was 20.6% with CyBorDComb, 23.5% with DCyBorSeq, and 0% with CyBorDSeq (p = 0.003). At day 455, mortality was not significantly different between regimens (p = 0.195). Acute toxicity of dexamethasone was evaluated on myocardial function using a rat model of isolated perfused heart. Administration of dexamethasone induced a decrease in left ventricular myocardium contractility and relaxation (p<0.05), supporting a potential negative inotropic effect of dexamethasone in AL-CA patients with severe cardiac involvement. Conclusion Delaying dexamethasone during the first chemotherapy cycle reduces the number of early deaths without extending survival. It is clear that dexamethasone is beneficial in the long-term treatment of patients with AL-CA. However, the initial introduction of dexamethasone during treatment is critical, but may be associated with early cardiac deaths in severe CA. Thus, it is important to consider the dosage and timing of dexamethasone introduction on a patient-severity basis. The impact of dexamethasone in the treatment of AL-CA needs further investigation.
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Affiliation(s)
- Mélanie Bézard
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
- * E-mail:
| | - Silvia Oghina
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Damien Vitiello
- Sport and Health Sciences Institute (I3SP–EA3625), Paris University, Paris, France
- Sorbonne University, Institut de Biologie Paris-Seine (IBPS), CNRS UMR 8256, Inserm ERL U1164, Adaptation biologique et vieillissement, Paris, France
| | - Mounira Kharoubi
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Ekaterini Kordeli
- Sorbonne University, Institut de Biologie Paris-Seine (IBPS), CNRS UMR 8256, Inserm ERL U1164, Adaptation biologique et vieillissement, Paris, France
| | - Arnault Galat
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Amira Zaroui
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Soulef Guendouz
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Floriane Gilles
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | | | - David Hamon
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Vincent Audard
- Nephrology and Transplantation Department, Rare Disease Reference Center «Syndrome Néphrotique Idiopathique», Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Emmanuel Teiger
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Elsa Poullot
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Anatomy and Cytopathology, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Valérie Molinier-Frenkel
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Immunology Laboratory, Créteil, France
| | - François Lemonnier
- Hematopathology-Lymphoid Unit, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Onnik Agbulut
- Sorbonne University, Institut de Biologie Paris-Seine (IBPS), CNRS UMR 8256, Inserm ERL U1164, Adaptation biologique et vieillissement, Paris, France
| | - Fabien Le Bras
- Hematopathology-Lymphoid Unit, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Thibaud Damy
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
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13
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Oghina S, Bougouin W, Bézard M, Kharoubi M, Komajda M, Cohen-Solal A, Mebazaa A, Damy T, Bodez D. The Impact of Patients With Cardiac Amyloidosis in HFpEF Trials. JACC Heart Fail 2021; 9:169-178. [PMID: 33549560 DOI: 10.1016/j.jchf.2020.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 01/13/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is an increasingly diagnosed condition whose failure to respond to new drugs effective in heart failure with reduced ejection fraction is of great concern. HFpEF is an incompletely understood and markedly heterogeneous syndrome, but cardiac amyloidosis is increasingly recognized as one of its various causes. The specific hemodynamic and pathophysiological features of cardiac amyloidosis result in poor tolerance of heart failure medications and in worse outcomes compared with other causes. Until recently, patients considered for HFpEF trials were not routinely screened for cardiac amyloidosis. This review examines how real-world patients with cardiac amyloidosis met inclusion criteria for 8 major HFpEF clinical trials, including the recent PARAGON (Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction) trial. This review discusses how the presence in the trial populations of a subset of patients with cardiac amyloidosis might contribute to explain the absence of efficacy of medications for HFpEF in trials so far. A multistep screening strategy is suggested in which patients with red flags for cardiac amyloidosis undergo both a light chain assay and technetium-labeled cardiac scintigraphy (technetium-labeled cardiac scintigraphy scan), which, when negative, rule out cardiac amyloidosis. Using this strategy would allow the testing of new medications for HFpEF in populations containing no patients with cardiac amyloidosis, thus potentially increasing the likelihood of showing therapeutic efficacy, and finally making some effective treatment available.
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Affiliation(s)
- Silvia Oghina
- French Referral Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France; Cardiology Department, Henri Mondor Teaching Hospital, Creteil, France.
| | - Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Mélanie Bézard
- French Referral Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France; Cardiology Department, Henri Mondor Teaching Hospital, Creteil, France
| | - Mounira Kharoubi
- French Referral Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France; Cardiology Department, Henri Mondor Teaching Hospital, Creteil, France
| | - Michel Komajda
- Cardiology Department, Paris Saint Joseph Hospital, Paris, France
| | - Alain Cohen-Solal
- UMR-S 942, Université de Paris, Cardiology Department, Lariboisiere Saint-Louis Teaching Hospital, AP-HP, Paris, France
| | - Alexandre Mebazaa
- UMR-S 942 MASCOT, Université de Paris, Department of Anesthesiology and Critical Care, Lariboisiere Saint-Louis Teaching Hospital, AP-HP, Paris, France
| | - Thibaud Damy
- French Referral Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France; Cardiology Department, Henri Mondor Teaching Hospital, Creteil, France; Paris XII University, UPEC, and IMRB-INSERM U955, Creteil, France
| | - Diane Bodez
- French Referral Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France; Cardiology Department, Henri Mondor Teaching Hospital, Creteil, France; Paris XII University, UPEC, and IMRB-INSERM U955, Creteil, France; Cardiology Outpatients Unit, Centre Cardiologique du Nord, Saint Denis, France
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14
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Bézard M, Kharoubi M, Galat A, Poullot E, Guendouz S, Fanen P, Funalot B, Moktefi A, Lefaucheur J, Deux JF, Gendre T, Audard V, El Karoui K, Canoui-Poitrine F, Zaroui A, Itti E, Teiger E, Plante V, Oghina S, Damy T. Natural history and impact of treatment with tafamidis on major cardiovascular outcome-free survival time in a cohort of patients with transthyretin amyloidosis. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kharoubi M, Roche F, Bézard M, Hupin D, Silva S, Oghina S, Chalard C, Zaroui A, Galat A, Guendouz S, Canoui-Poitrine F, Hittinger L, Teiger E, Lefaucheur JP, Damy T. Prevalence and prognostic value of autonomic neuropathy assessed by Sudoscan® in transthyretin wild-type cardiac amyloidosis. ESC Heart Fail 2020; 8:1656-1665. [PMID: 33354901 PMCID: PMC8006719 DOI: 10.1002/ehf2.13131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/18/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022] Open
Abstract
Aims The prevalence of autonomic neuropathy (AN) is high in patients with hereditary transthyretin amyloidosis but remains unknown in transthyretin wild‐type cardiac amyloidosis (ATTRwt‐CA). This study aimed to determine the prevalence of AN in patients with ATTRwt‐CA using Sudoscan®, a non‐invasive method used to provide evidence of AN in clinical practice and based on measurement of electrochemical skin conductance at the hands and feet (fESC). Methods and results A series of 62 non‐diabetic patients with ATTRwt‐CA was prospectively included over 2 years and compared with healthy elderly subjects, matched by age, gender, and body mass index. The presence of AN was defined as electrochemical skin conductance at the hands <60 μS and/or fESC <70 μS, and conductances were analysed according to clinical, biological, and echocardiographic data. Mean fESC was significantly lower in patients with ATTRwt‐CA compared with elderly controls: 68.3 (64.1–72.5) vs. 76.9 (75.6–78.1) μS (P < 0.0001), respectively. Prevalence of fESC <70 μS was higher in ATTRwt‐CA patients than in controls: 48.4% vs. 19.9%, P < 0.05. Univariate analysis showed that fESC, N‐terminal pro‐B‐type natriuretic peptide, creatinine plasma levels, and echocardiographic global longitudinal strain were associated with decompensated cardiac failure and death. Multivariate analysis revealed that fESC was an independent prognostic factor, and Kaplan–Meier estimator evidenced a greater occurrence of cardiac decompensation and death in patients with fESC <70 μS, P = 0.046. Conclusions Reduced fESC was observed in almost 50% of patients with ATTRwt‐CA and was associated with a worse prognosis. Sudoscan® could easily be used to screen ATTRwt‐CA patients for the presence of AN and identify patients at higher risk for a poor outcome.
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Affiliation(s)
- Mounira Kharoubi
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France
| | - Fréderic Roche
- CHU Saint Etienne, Clinical Physiology and Exercise Department, VISAS Centre, Saint-Etienne, France.,University Jean Monnet, EA 4607, SNA EPIS, Saint-Etienne, France
| | - Mélanie Bézard
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France
| | - David Hupin
- CHU Saint Etienne, Clinical Physiology and Exercise Department, VISAS Centre, Saint-Etienne, France.,University Jean Monnet, EA 4607, SNA EPIS, Saint-Etienne, France
| | - Sidney Silva
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France
| | - Silvia Oghina
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France
| | - Coraline Chalard
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France
| | - Amira Zaroui
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,Cardiology Department, CHU la Rabta, Jebbari Tunis, Tunisia
| | - Arnault Galat
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France
| | - Soulef Guendouz
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France
| | - Florence Canoui-Poitrine
- Public Health Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Luc Hittinger
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France
| | - Emmanuel Teiger
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France
| | - Jean-Pascal Lefaucheur
- Université Paris-Est Créteil, EA 4391, ENT, Créteil, France.,Clinical Neurophysiology Unit, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- Cardiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Créteil, France.,GRC Amyloid Research Institute, Créteil, France.,DHU-ATVB, Créteil, France.,Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Créteil, France
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16
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Bézard M, Kharoubi M, Galat A, Poullot E, Guendouz S, Fanen P, Funalot B, Moktefi A, Lefaucheur JP, Abulizi M, Deux JF, Gendre T, Audard V, El Karoui K, Canoui-Poitrine F, Zaroui A, Itti E, Teiger E, Planté-Bordeneuve V, Oghina S, Damy T. Natural history and impact of treatment with tafamidis on major cardiovascular outcome-free survival time in a cohort of patients with transthyretin amyloidosis. Eur J Heart Fail 2020; 23:264-274. [PMID: 33094885 DOI: 10.1002/ejhf.2028] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 12/27/2022] Open
Abstract
AIMS Hereditary (ATTRv) and wild-type (ATTRwt) transthyretin amyloidosis are severe and fatal systemic diseases, characterised by amyloid fibrillar accumulation principally in the heart or peripheral nerves (or both). Since 2012, tafamidis has been used in France to treat patients with ATTRv with neuropathy (alone or combined with cardiomyopathy). Recently, the Phase III ATTR-ACT trial showed that tafamidis decreased the relative risk of mortality in ATTR amyloidosis with cardiomyopathy. The aims of this study were to assess the clinical characteristics of ATTR amyloidosis in a real-life population in comparison to the population included in the ATTR-ACT trial and to assess the impact of tafamidis treatment on major cardiovascular outcome (MCO)-free survival time without cardiac decompensation, heart transplant, or death. METHODS AND RESULTS From June 2008 to November 2018, 648 patients with ATTR amyloidosis (423 ATTRwt and 225 ATTRv) consecutively referred to the French Referral Center for cardiac amyloidosis were included. A total of 467 (72%) patients matched the inclusion criteria of the ATTR-ACT trial. For the 631 patients with cardiomyopathy, tafamidis treatment was associated with a longer median MCO-free survival time (n = 98): 1565 (1010-2400) days vs. 771 (686-895) days without treatment (log-rank P < 0.001). This association was confirmed after considering confounding factors (age at inclusion, N-terminal pro-B-type natriuretic peptide and amyloidosis type) with a propensity score (hazard ratio 0.546; P = 0.0132). CONCLUSION In a large cohort of ATTRwt and ATTRv patients, representative of the inclusion criteria of the ATTR-ACT trial, the present results show an association between tafamidis treatment and a lower occurrence of cardiovascular outcomes in a real-life population.
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Affiliation(s)
- Mélanie Bézard
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, DHU-ATVB, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Inserm U955, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Mounira Kharoubi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, DHU-ATVB, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Inserm U955, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Arnault Galat
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, DHU-ATVB, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Inserm U955, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Elsa Poullot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Pathology Department, Créteil, France
| | - Soulef Guendouz
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, DHU-ATVB, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Inserm U955, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Pascale Fanen
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Genetics Department, Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Genetics Department, Henri Mondor University Hospital, Créteil, France
| | - Anissa Moktefi
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Pathology Department, Créteil, France
| | - Jean-Pascal Lefaucheur
- EA4391, ENT, Université Paris Est Créteil 8 rue du General Sarrail, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Neurophysiology Unit, Henri Mondor University Hospital, Créteil, France
| | - Mukedaisi Abulizi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Nuclear Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Jean-François Deux
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Inserm U955, Université Paris-Est Créteil (UPEC), Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Radiology Department, Henri Mondor University Hospital, Créteil, France
| | - Thierry Gendre
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Neurology Department, Henri Mondor University Hospital, Créteil, France
| | - Vincent Audard
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology and Renal Transplantation Department, Henri Mondor University Hospital, Créteil, France.,Univsité Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Khalil El Karoui
- AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology and Renal Transplantation Department, Henri Mondor University Hospital, Créteil, France.,Univsité Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Florence Canoui-Poitrine
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Departement, Henri Mondor University Hospital, Créteil, France
| | - Amira Zaroui
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, DHU-ATVB, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,CHU la Rabta, Cardiology Department, Jebbari Tunis, Tunisia
| | - Emmanuel Itti
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Nuclear Medicine Department, Henri Mondor University Hospital, Créteil, France.,Univsité Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Emmanuel Teiger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, DHU-ATVB, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Inserm U955, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Violaine Planté-Bordeneuve
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Neurology Department, Henri Mondor University Hospital, Créteil, France
| | - Silvia Oghina
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, DHU-ATVB, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, DHU-ATVB, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Inserm U955, Université Paris-Est Créteil (UPEC), Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Investigation Center 1430, Henri Mondor University Hospital, Créteil, France
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17
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Gilles F, Damy T, Bodez D, Galat A, Guendouz S, Dubois-Rande J, Issaurat P, Bézard M, Oghina S, Kharoubi M, Frenkel V, Mokhri A, Lebras F, Beladj K, Dupuis J. Effect on mortality of combined or sequential chemotherapy in patients with cardiac light-chain amyloidosis. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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