Giacomo Tini1,2, Francesco Cappelli3, Elena Biagini4, Beatrice Musumeci2, Marco Merlo5, Lia Crotti6, Matteo Cameli7, Gianluca Di Bella8, Alberto Cipriani9, Francesca Marzo10, Federico Guerra11, Cinzia Forleo12, Christian Gagliardi4, Mattia Zampieri3, Samuela Carigi10, Pier Filippo Vianello1, Giulia Elena Mandoli7, Giuseppe Ciliberti11, Luca Lichelli9, Davide Mariani6, Aldostefano Porcari5, Domitilla Russo2, Roberto Licordari8, Alberto Ponziani4, Italo Porto1,13, Federico Perfetto3, Camillo Autore2, Claudio Rapezzi14,15, Giafranco Sinagra5, Marco Canepa1,13. 1. Department of Internal Medicine, University of Genova, Viale Benedetto XV, 10, Genova, 16132, Italy. 2. Cardiology, Clinical and Molecular Medicine Department, Sapienza University of Rome, Rome, Italy. 3. Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy. 4. Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 5. Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy. 6. Department of Cardiovascular, Neural and Metabolic Sciences, University of Milano-Bicocca, Istituto Auxologico Italiano, IRCCS, Milan, Italy. 7. Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy. 8. Rare Cardiac Disease Center, Cardiology Unit, University of Messina, Messina, Italy. 9. Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy. 10. Cardiology Unit, Infermi Hospital, Rimini, Italy. 11. Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I -Lancisi - Salesi", Ancona, Italy. 12. Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, University Hospital Policlinico Consorziale, Bari, Italy. 13. Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network, Genova, Italy. 14. University Cardiological Center, University of Ferrara, Ferrara, Italy. 15. Maria Cecilia Hospital, GVM Care & Research, Ravenna, Italy.
Abstract
AIMS: The use of beta-blocker therapy in cardiac amyloidosis (CA) is debated. We aimed at describing patterns of beta-blocker prescription through a nationwide survey. METHODS AND RESULTS: From 11 referral centres, we retrospectively collected data of CA patients with a first evaluation after 2016 (n = 642). Clinical characteristics at first and last evaluation were collected, with a focus on medical therapy. For patients in whom beta-blocker therapy was started, stopped, or continued between first and last evaluation, the main reason for beta-blocker management was requested. Median age of study population was 77 years; 81% were men. Arterial hypertension was found in 58% of patients, atrial fibrillation (AF) in 57%, and coronary artery disease in 16%. Left ventricular ejection fraction was preserved in 62% of cases, and 74% of patients had advanced diastolic dysfunction. Out of the 250 CA patients on beta-blockers at last evaluation, 215 (33%) were already taking this therapy at first evaluation, while 35 (5%) were started it, in both cases primarily because of high-rate AF. One-hundred-nineteen patients (19%) who were on beta-blocker at first evaluation had this therapy withdrawn, mainly because of intolerance in the presence of heart failure with advanced diastolic dysfunction. The remaining 273 patients (43%) had never received beta-blocker therapy. Beta-blockers usage was similar between CA aetiologies. Patients taking vs. not taking beta-blockers differed only for a greater prevalence of arterial hypertension, coronary artery disease, AF, and non-restrictive filling pattern (P < 0.01 for all) in the former group. CONCLUSIONS: Beta-blockers prescription is not infrequent in CA. Such therapy may be tolerated in the presence of co-morbidities for which beta-blockers are routinely used and in the absence of advanced diastolic dysfunction.
AIMS: The use of beta-blocker therapy in cardiac amyloidosis (CA) is debated. We aimed at describing patterns of beta-blocker prescription through a nationwide survey. METHODS AND RESULTS: From 11 referral centres, we retrospectively collected data of CA patients with a first evaluation after 2016 (n = 642). Clinical characteristics at first and last evaluation were collected, with a focus on medical therapy. For patients in whom beta-blocker therapy was started, stopped, or continued between first and last evaluation, the main reason for beta-blocker management was requested. Median age of study population was 77 years; 81% were men. Arterial hypertension was found in 58% of patients, atrial fibrillation (AF) in 57%, and coronary artery disease in 16%. Left ventricular ejection fraction was preserved in 62% of cases, and 74% of patients had advanced diastolic dysfunction. Out of the 250 CA patients on beta-blockers at last evaluation, 215 (33%) were already taking this therapy at first evaluation, while 35 (5%) were started it, in both cases primarily because of high-rate AF. One-hundred-nineteen patients (19%) who were on beta-blocker at first evaluation had this therapy withdrawn, mainly because of intolerance in the presence of heart failure with advanced diastolic dysfunction. The remaining 273 patients (43%) had never received beta-blocker therapy. Beta-blockers usage was similar between CA aetiologies. Patients taking vs. not taking beta-blockers differed only for a greater prevalence of arterial hypertension, coronary artery disease, AF, and non-restrictive filling pattern (P < 0.01 for all) in the former group. CONCLUSIONS: Beta-blockers prescription is not infrequent in CA. Such therapy may be tolerated in the presence of co-morbidities for which beta-blockers are routinely used and in the absence of advanced diastolic dysfunction.