Time trajectory of cardiac function and its relation with survival in patients with light-chain cardiac amyloidosis. (12th June 2020)

• Record Type: Journal Article
• Authors: Hwang, In-Chang; Koh, Youngil; Park, Jun-Bean; Yoon, Yeonyee E; Kim, Hack-Lyoung; Kim, Hyung-Kwan; Kim, Yong-Jin; Cho, Goo-Yeong; Sohn, Dae-Won; Lee, Seung-Pyo
• Is Part Of: European heart journal. Volume 22:Number 4(2021)
• Page Start: 459
• Page End: 469
• Publication Date: 2020-06-12
• Subjects: cardiac amyloidosis -- AL amyloidosis -- light-chain amyloidosis -- global longitudinal strain -- echocardiography; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa146
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims : We aimed to analyse the time-serial change of cardiac function in light-chain (AL) cardiac amyloidosis patients undergoing active chemotherapy and its relationship with patient outcome. Methods and results : Seventy-two patients with AL cardiac amyloidosis undergoing active chemotherapy who had two or more echocardiographic examinations were identified from a prospective observational cohort ( n = 34) and a retrospective cohort ( n = 38). Echocardiographic parameters were obtained immediately prior to 1–3, 3–6, 6–12, and 12–24 months after the first chemotherapy. Study endpoint was a composite of death or heart transplantation (HT). During a median of 32 months (interquartile range 8–51) follow-up, 33 patients (45.8%) died and 4 patients (5.6%) underwent HT. Echocardiograms immediately prior to the first chemotherapy did not show differences between the patients with adverse events vs. those without. Significant increase in mitral E/e′ ratio and decline in left ventricular global longitudinal strain (LV-GLS) was observed, starting at 3–6 months after the first chemotherapy only in those who experienced adverse events on follow-up, which was also evident in those who responded to chemotherapy. Multivariate analysis demonstrated that B-natriuretic peptide >500 pg/mL and troponin I >0.15 ng/dL at initial diagnosis, hospitalization for heart failure, E/e′ >15, and LV-GLS <10% during follow-up were independent predictors of outcome. Conclusions : In AL cardiac amyloidosis patients undergoing active chemotherapy, the deterioration of LV function may occur, starting even at 3–6 months after the first chemotherapy. Serial echocardiography may help identify those who experience a clinical event in the near future despite active chemotherapy.