Michael M Kreusser1,2, Martin J Volz3, Benjamin Knop3, Philipp Ehlermann3, Bastian Schmack4, Arjang Ruhparwar5,4, Ute Hegenbart6, Stefan O Schönland6, Hugo A Katus3,5, Philip W Raake3,5. 1. Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. Michael.kreusser@med.uni-heidelberg.de. 2. DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany. Michael.kreusser@med.uni-heidelberg.de. 3. Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. 4. Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany. 5. DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany. 6. Division of Hematology and Oncology, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
Abstract
BACKGROUND: Cardiac amyloidosis, caused by deposition of immunoglobulin light chains (AL) or transthyretin (ATTR), carries a poor prognosis. Established risk scores for amyloidosis may not predict outcomes in those patients who develop advanced heart failure and who are potential candidates for heart transplantation. Here, we aimed to identify predictive parameters for patients with severe heart failure due to amyloidosis. METHODS: Out of > 1000 patients with cardiac amyloidosis (AL or ATTR) admitted to our centre between September 1998 and January 2016, a cohort of 120 patients with a complete cardiac assessment at diagnosis, including right heart catheterization, echocardiography and biomarkers, was analysed retrospectively in this study. Primary endpoint was all-cause mortality. We performed univariate and multivariate Cox regression analysis, generated risk scores to predict outcomes in AL and ATTR amyloidosis and compared those to established risk models for amyloidosis. RESULTS: In the Cox multivariate model, high-sensitivity troponin T (hsTnT; hazard ratio (HR) 1.003; confidence interval (CI) 1.001-1.005; p = 0.009) and mean pulmonary artery pressure (HR 1.061; CI 1.024-1.100; p = 0.001) were found to significantly and independently predict outcomes for AL amyloidosis, whereas QRS duration (HR 1.021; CI 1.004-1.039; p = 0.013), hsTnT (HR 1.021; CI 1.006-1.036; p = 0.006) and N-terminal pro-brain natriuretic peptide (HR 1.0003; CI 1.0001-1.0004; p = 0.002) were the best predictors for ATTR amyloidosis. A simple risk score ("HeiRisk") including these parameters for AL and ATTR allowed a more precise risk stratification in our patient population compared to established risk models. CONCLUSIONS: Risk stratification for cardiac amyloidosis with the newly developed "HeiRisk" score may be superior to other staging systems for patients with advanced heart failure due to amyloid cardiomyopathy.
BACKGROUND:Cardiac amyloidosis, caused by deposition of immunoglobulin light chains (AL) or transthyretin (ATTR), carries a poor prognosis. Established risk scores for amyloidosis may not predict outcomes in those patients who develop advanced heart failure and who are potential candidates for heart transplantation. Here, we aimed to identify predictive parameters for patients with severe heart failure due to amyloidosis. METHODS: Out of > 1000 patients with cardiac amyloidosis (AL or ATTR) admitted to our centre between September 1998 and January 2016, a cohort of 120 patients with a complete cardiac assessment at diagnosis, including right heart catheterization, echocardiography and biomarkers, was analysed retrospectively in this study. Primary endpoint was all-cause mortality. We performed univariate and multivariate Cox regression analysis, generated risk scores to predict outcomes in AL and ATTRamyloidosis and compared those to established risk models for amyloidosis. RESULTS: In the Cox multivariate model, high-sensitivity troponin T (hsTnT; hazard ratio (HR) 1.003; confidence interval (CI) 1.001-1.005; p = 0.009) and mean pulmonary artery pressure (HR 1.061; CI 1.024-1.100; p = 0.001) were found to significantly and independently predict outcomes for AL amyloidosis, whereas QRS duration (HR 1.021; CI 1.004-1.039; p = 0.013), hsTnT (HR 1.021; CI 1.006-1.036; p = 0.006) and N-terminal pro-brain natriuretic peptide (HR 1.0003; CI 1.0001-1.0004; p = 0.002) were the best predictors for ATTRamyloidosis. A simple risk score ("HeiRisk") including these parameters for AL and ATTR allowed a more precise risk stratification in our patient population compared to established risk models. CONCLUSIONS: Risk stratification for cardiac amyloidosis with the newly developed "HeiRisk" score may be superior to other staging systems for patients with advanced heart failure due to amyloid cardiomyopathy.
Entities:
Keywords:
Biomarkers; Cardiac amyloidosis; Haemodynamics; Heart failure; Predictors of survival
Authors: Jan Wintrich; Ingrid Kindermann; Christian Ukena; Simina Selejan; Christian Werner; Christoph Maack; Ulrich Laufs; Carsten Tschöpe; Stefan D Anker; Carolyn S P Lam; Adriaan A Voors; Michael Böhm Journal: Clin Res Cardiol Date: 2020-03-31 Impact factor: 5.460
Authors: Michael M Kreusser; Sonja Hamed; Andreas Weber; Bastian Schmack; Martin J Volz; Nicolas A Geis; Leonie Grossekettler; Sven T Pleger; Arjang Ruhparwar; Hugo A Katus; Philip W Raake Journal: ESC Heart Fail Date: 2020-10-26
Authors: Christina Binder; Franz Duca; Thomas Binder; René Rettl; Theresa Marie Dachs; Benjamin Seirer; Luciana Camuz Ligios; Fabian Dusik; Christophe Capelle; Hong Qin; Hermine Agis; Renate Kain; Christian Hengstenberg; Roza Badr Eslam; Diana Bonderman Journal: Clin Res Cardiol Date: 2020-09-10 Impact factor: 5.460