Role of natriuretic peptide to predict cardiac abnormalities in patients with hereditary transthyretin amyloidosis. (December 2013)

• Record Type: Journal Article
• Authors: Damy, Thibaud; Deux, Jean-François; Moutereau, Stéphane; Guendouz, Soulef; Mohty, Dania; Rappeneau, Stéphane; Guellich, Aziz; Hittinger, Luc; Loric, Sylvain; Lefaucheur, Jean-Pascal; Plante-Bordeneuve, Violaine
• Is Part Of: Amyloid. Volume 20:Number 4(2013:Dec.)
• Page Start: 212
• Page End: 220
• Publication Date: 2013-12
• Subjects: Amyloidosis -- Periodicals; 616.3995
• DOI: 10.3109/13506129.2013.825240
• Languages: English
• ISSNs: 1350-6129

Abstract

<abstract> <title>Abstract</title> <p> <italic>Background</italic>: Familial amyloid polyneuropathy (FAP) mainly targets the peripheral nervous system and heart. Early noninvasive detection of cardiac impairment is critical for therapeutic management.</p> <p> <italic>Aim</italic>: To assess if amino-terminal pro-brain natriuretic peptide (NT-proBNP) or troponin T (cTnT) can predict echocardiographic left-ventricle (LV) impairment in FAP.</p> <p> <italic>Methods</italic>: Thirty-six asymptomatic carriers and patients with FAP had echocardiographic measurement of left-ventricular (LV) systolic function, hypertrophy (LVH) and estimation of filling pressure (FP).</p> <p> <italic>Results</italic>: Overall, median age, NT-proBNP, and LV ejection fraction were, respectively, 59 years (41–74), 323 pg/ml (58–1960), and 60% (51–66). Twelve patients had increased cTnT. Prevalence of ATTR gene mutations was 53% for <italic>Val30Me</italic>t. Four individuals were asymptomatic, 6 patients had isolated neurological clinical signs, and 26 had echo-LV abnormalities. The ROC curve identified NT-proBNP patients with echo-LV abnormalities (area: 0.92; (0.83–0.99), <italic>p</italic> = 0.001) at a threshold >82 pg/ml with a sensitivity of 92%, and a specificity of 90%. Increased in NT-proBNP occurred in patients with SD and/or LVH with or without increase in FP. Elevated cTnT (>0.01ng/ml) was only observed in patients with LVH and systolic dysfunction, with or without FP.</p> <p> <italic>Conclusion</italic>: In FAP, NT-proBNP was associated with cardiac impairment suggesting that NT-proBNP could be used in carriers or in FAP patients with only neurologic symptoms for identifying the appropriate time to start cardiac echocardiographic assessment and follow-up. cTnT identified patients with severe cardiac disease.</p> </abstract>