1
|
Badr Eslam R, Öztürk B, Rettl R, Capelle CDJ, Qin H, Binder C, Dachs TM, Camuz Ligios L, Duca F, Dalos D, Schrutka L, Alasti F, Kastner J, Vila G, Bonderman D. Impact of Tafamidis and Optimal Background Treatment on Physical Performance in Patients With Transthyretin Amyloid Cardiomyopathy. Circ Heart Fail 2022; 15:e008381. [PMID: 35766028 DOI: 10.1161/circheartfailure.121.008381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/16/2022]
Abstract
BACKGROUND In patients with transthyretin amyloid cardiomyopathy, tafamidis was shown to slow the decline in 6-minute walking distance as compared with placebo. We aimed to define the impact of tafamidis and optimal background treatment on functional capacity as determined by cardiopulmonary exercise testing (CPET). METHODS Seventy-eight consecutive patients were enrolled in the study. They underwent CPET at baseline, and outcome defined as death or heart failure hospitalization was obtained for a time period of up to 30 months. Fifty-four patients completed a follow-up CPET at 9±3 months (range, 4-16 months). Improvement in peak VO2 at follow-up was defined as ∆peak VO2≥1.0 mL/(kg·min), stable peak VO2 was defined as 0≤∆peak VO2<1.0 mL/(kg·min), and decline in peak VO2 was defined by ∆peak VO2<0 mL/(kg·min). RESULTS Baseline peak VO2>14 mL/(kg·min) as well as minute ventilation/carbon dioxide production slope≤34 were associated with a lower risk of death or heart failure hospitalization (P=0.002, P=0.007, respectively). In 54 patients, who received tafamidis and underwent repeat CPET testing, an improvement in physical performance (P=0.002) was observed at follow-up. When comparing pre and post-treatment parameters, 29 patients (54%) showed an increase in percent predicted peak VO2 (P<0.0001), an improvement of peak VO2 (P<0.0001), and better physical performance at follow-up (P<0.0001). Patients with stable or improved peak VO2 had less advanced heart disease at baseline (P=0.046). CONCLUSIONS Our findings demonstrate that baseline peak VO2 and baseline minute ventilation/carbon dioxide production slope predict outcomes and an improvement in physical performance as measured by CPET was observed in patients receiving tafamidis, who had less advanced disease at baseline, emphasizing the importance of early diagnosis.
Collapse
Affiliation(s)
- Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Begüm Öztürk
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - René Rettl
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Christophe Denis Josef Capelle
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Hong Qin
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Christina Binder
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Theresa-Marie Dachs
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Luciana Camuz Ligios
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Daniel Dalos
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Lore Schrutka
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Farideh Alasti
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria (F.A.)
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Greisa Vila
- Division of Endocrinology and Metabolism, Department of Internal Medicine III (G.V.), Medical University of Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| |
Collapse
|