Francesco Cappelli1,2, Giacomo Tini3,4, Domitilla Russo5, Michele Emdin6,7, Annamaria Del Franco6,7, Giuseppe Vergaro6,7, Gianluca Di Bella8, Anna Mazzeo8, Marco Canepa3,4, Massimo Volpe5,9, Federico Perfetto1, Camillo Autore5, Carlo Di Mario2, Claudio Rapezzi10,11, Maria Beatrice Musumeci5. 1. Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy. 2. Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy. 3. Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy. 4. IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy. 5. Cardiology, Clinical and Molecular Medicine Department, Sapienza University of Rome, Rome, Italy. 6. Institute of Life Science, Scuola Sant'Anna, Pisa, Italy. 7. Fondazione Toscana G. Monasterio, Pisa, Italy. 8. Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy. 9. IRCCS Neuromed, Pozzilli, Italy. 10. Centro Cardiologico Universitario di Ferrara, University of Ferrara, Ferrara, Italy. 11. Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy.
Abstract
BACKGROUND: Intracardiac thrombosis is reported to occur frequently in cardiac amyloidosis (CA). However, data regarding arterial thrombo-embolic events (AEs) in CA are limited. We aimed at assessing prevalence, clinical characteristics and predictors of AEs in a large multicentric CA cohort. METHODS AND RESULTS: Four-hundred-six consecutive CA patients (134 AL, 73 ATTRm and 199 ATTRwt) from 5 Italian referral centres were retrospectively evaluated and followed-up for a median time of 19 months. Thirty-one patients (7.6%) suffered from an AE, of whom 10 (32.2%) were in sinus rhythm and had no history of AF. There were no significant differences in terms of age, gender and type of CA between patients with or without AEs. Fourteen (7.6%) of 185 patients on anticoagulation had an AE despite therapy. Anticoagulation therapy did not appear to fully protect from the risk of events (HR 1.23, 95%CI 0.52-2.92, p = .64). The only predictor of AEs, in particular among CA patients in sinus rhythm, was a CHA2DS2-VASC score ≥ 3 (HR 2.84, 95%CI 1.02-7.92, p = .05 in overall population; HR 10.13, 95%CI 1.12-91.19, p = .04 in patients in sinus rhythm). CONCLUSIONS: In our large, multicentric, real-world cohort, prevalence and incidence rate of AEs was high. A consistent proportion of events occurred despite anticoagulation therapy or in patients in sinus rhythm. A higher CHA2DS2-VASc score might identify patients at risk of AEs also among those in sinus rhythm.
BACKGROUND: Intracardiac thrombosis is reported to occur frequently in cardiac amyloidosis (CA). However, data regarding arterial thrombo-embolic events (AEs) in CA are limited. We aimed at assessing prevalence, clinical characteristics and predictors of AEs in a large multicentric CA cohort. METHODS AND RESULTS: Four-hundred-six consecutive CA patients (134 AL, 73 ATTRm and 199 ATTRwt) from 5 Italian referral centres were retrospectively evaluated and followed-up for a median time of 19 months. Thirty-one patients (7.6%) suffered from an AE, of whom 10 (32.2%) were in sinus rhythm and had no history of AF. There were no significant differences in terms of age, gender and type of CA between patients with or without AEs. Fourteen (7.6%) of 185 patients on anticoagulation had an AE despite therapy. Anticoagulation therapy did not appear to fully protect from the risk of events (HR 1.23, 95%CI 0.52-2.92, p = .64). The only predictor of AEs, in particular among CA patients in sinus rhythm, was a CHA2DS2-VASC score ≥ 3 (HR 2.84, 95%CI 1.02-7.92, p = .05 in overall population; HR 10.13, 95%CI 1.12-91.19, p = .04 in patients in sinus rhythm). CONCLUSIONS: In our large, multicentric, real-world cohort, prevalence and incidence rate of AEs was high. A consistent proportion of events occurred despite anticoagulation therapy or in patients in sinus rhythm. A higher CHA2DS2-VASc score might identify patients at risk of AEs also among those in sinus rhythm.
Authors: Maria Papathanasiou; Aiste-Monika Jakstaite; Sara Oubari; Johannes Siebermair; Reza Wakili; Julia Hoffmann; Alexander Carpinteiro; Tim Hagenacker; Andreas Thimm; Christoph Rischpler; Lukas Kessler; Tienush Rassaf; Peter Luedike Journal: ESC Heart Fail Date: 2022-02-17