Thomas d'Humières1, Damien Fard1, Thibaud Damy1, Francois Roubille2, Arnaud Galat1, Huy-Long Doan1, Leopold Oliver1, Jean-Luc Dubois-Randé1, Pierre Squara3, Pascal Lim4, Julien Ternacle1. 1. UPEC, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France; Inserm U955, 94000 Créteil, France; DHU ATVB, 94000 Créteil, France. 2. Cardiology Department, University Hospital of Montpellier, 34090 Montpellier, France. 3. Clinique Ambroise-Paré, CERIC, 92200 Neuilly-sur-Seine, France. 4. UPEC, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France; Inserm U955, 94000 Créteil, France; DHU ATVB, 94000 Créteil, France. Electronic address: lim.pascal.hmn@gmail.com.
Abstract
BACKGROUND: The outcome of cardiac amyloidosis (CA) has been reported mainly in stable populations; limited data are available in patients referred for acute heart failure (AHF) to an intensive cardiac care unit (ICCU). AIMS: To address the characteristics and outcomes of patients with confirmed CA admitted to an ICCU for AHF and then to identify the predictors of evolution to cardiogenic shock. METHODS: All patients with CA referred to an ICCU for AHF between 2009 and 2015 were included. The clinical endpoint was 3-month death. Data from the population with cardiogenic shock, obtained in a stable haemodynamic state, were matched with data from a control group to determine predictors of evolution to cardiogenic shock. RESULTS: Among the 421 patients followed for CA in our expert centre, 46 patients (mean age: 64±14 years; 65% light-chain [AL] CA) were referred to the ICCU for AHF (n=26 with cardiogenic shock). At 3 months, death occurred in 24 (52%) patients, mostly in the cardiogenic shock group (n=21/26, 81%). Most deaths occurred 5 days [interquartile range 3-9 days] after catecholamine infusion and 50% occurred in patients aged<65 years. The majority of deaths were reported in patients with AL CA (n=19/24, 79%). Independent variables associated with in-hospital mortality were cardiogenic shock and uraemia level. N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration obtained in a stable haemodynamic state was the only predictor of short-term evolution to cardiogenic shock (odds ratio: 8.7, 95% confidence interval: 2.2-34.6), with an optimal cut-off of 4040pg/mL (sensitivity=92%; specificity=81%). CONCLUSIONS: The study confirms the dramatic mortality associated with CA when presenting as cardiogenic shock and underlines the limited efficiency of conventional treatments. Given the rapid occurrence of death in a young population, an alternative strategy to dobutamine support should be investigated in patients with elevated NT-proBNP concentration.
BACKGROUND: The outcome of cardiac amyloidosis (CA) has been reported mainly in stable populations; limited data are available in patients referred for acute heart failure (AHF) to an intensive cardiac care unit (ICCU). AIMS: To address the characteristics and outcomes of patients with confirmed CA admitted to an ICCU for AHF and then to identify the predictors of evolution to cardiogenic shock. METHODS: All patients with CA referred to an ICCU for AHF between 2009 and 2015 were included. The clinical endpoint was 3-month death. Data from the population with cardiogenic shock, obtained in a stable haemodynamic state, were matched with data from a control group to determine predictors of evolution to cardiogenic shock. RESULTS: Among the 421 patients followed for CA in our expert centre, 46 patients (mean age: 64±14 years; 65% light-chain [AL] CA) were referred to the ICCU for AHF (n=26 with cardiogenic shock). At 3 months, death occurred in 24 (52%) patients, mostly in the cardiogenic shock group (n=21/26, 81%). Most deaths occurred 5 days [interquartile range 3-9 days] after catecholamine infusion and 50% occurred in patients aged<65 years. The majority of deaths were reported in patients with AL CA (n=19/24, 79%). Independent variables associated with in-hospital mortality were cardiogenic shock and uraemia level. N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration obtained in a stable haemodynamic state was the only predictor of short-term evolution to cardiogenic shock (odds ratio: 8.7, 95% confidence interval: 2.2-34.6), with an optimal cut-off of 4040pg/mL (sensitivity=92%; specificity=81%). CONCLUSIONS: The study confirms the dramatic mortality associated with CA when presenting as cardiogenic shock and underlines the limited efficiency of conventional treatments. Given the rapid occurrence of death in a young population, an alternative strategy to dobutamine support should be investigated in patients with elevated NT-proBNP concentration.
Authors: Sameer Arora; Nikita S Patil; Paula D Strassle; Arman Qamar; Muthiah Vaduganathan; Amber Fatima; Kalyan Mogili; Deepak Garipalli; Justin L Grodin; John P Vavalle; Gregg C Fonarow; Deepak L Bhatt; Ambarish Pandey Journal: JACC CardioOncol Date: 2020-12-15
Authors: Maaike Brons; Steven A Muller; Frans H Rutten; Manon G van der Meer; Alexander F J E Vrancken; Monique C Minnema; Annette F Baas; Folkert W Asselbergs; Marish I F J Oerlemans Journal: Eur Heart J Open Date: 2022-02-24