Prognostic value of cardiopulmonary exercise testing in patients with transthyretin cardiac amyloidosis
© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI)..
The aim of this study is to evaluate the prognostic value of cardiopulmonary testing (CPET) in a cohort of patients with transthyretin cardiac amyloidosis (ATTR-CA). ATTR-CA is associated with a progressive reduction in functional capacity. The prognostic role of CPET parameters and in particular of normalized peak VO2 (%ppVO2) remains to be thoroughly evaluated. In this study, 75 patients with ATTR-CA underwent cardiological evaluation and CPET in a National Referral Center for cardiac amyloidosis (Careggi University Hospital, Florence). Fifty-seven patients (76%) had wild-type ATTR. Median age was 80 (75-83) years, 68 patients (91%) were men. Peak oxygen consumption (14.1 ± 4.1 ml/kg/min) and %ppVO2 (68.4 ± 18.8%) were blunted. Twenty-seven (36%) patients had an abnormal pressure response to exercise. After a median follow-up of 25 (12-31) months, the composite outcome of death or heart failure hospitalization was registered in 19 (25.3%) patients. At univariate analysis %ppVO2 was a stronger predictor for the composite outcome than peak VO2. %ppVO2 and NT-proBNP remained associated with the composite outcome at multivariate analysis. The optimal predictive threshold for %ppVO2 was 62% (sensitivity: 71%; specificity: 68%; AUC: 0.77, CI 0.65-0.88). Patients with %ppVO2 ≤ 62%and NT-proBNP > 3000 pg had a worse prognosis with 1- and 2-year survival of 69 ± 9% and 50 ± 10%, respectively. CPET is a safe and useful prognostic tool in patients with ATTR-CA. CPET may help to identify patients with advanced disease that may benefit from targeted therapy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
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| Enthalten in: |
Internal and emergency medicine - 18(2023), 2 vom: 17. März, Seite 585-593 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Silverii, Maria Vittoria [VerfasserIn] |
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| Links: |
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| Themen: |
CPET |
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| Anmerkungen: |
Date Completed 20.03.2023 Date Revised 29.07.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s11739-022-03125-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM349101248 |
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| 245 | 1 | 0 | |a Prognostic value of cardiopulmonary exercise testing in patients with transthyretin cardiac amyloidosis |
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| 520 | |a © 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI). | ||
| 520 | |a The aim of this study is to evaluate the prognostic value of cardiopulmonary testing (CPET) in a cohort of patients with transthyretin cardiac amyloidosis (ATTR-CA). ATTR-CA is associated with a progressive reduction in functional capacity. The prognostic role of CPET parameters and in particular of normalized peak VO2 (%ppVO2) remains to be thoroughly evaluated. In this study, 75 patients with ATTR-CA underwent cardiological evaluation and CPET in a National Referral Center for cardiac amyloidosis (Careggi University Hospital, Florence). Fifty-seven patients (76%) had wild-type ATTR. Median age was 80 (75-83) years, 68 patients (91%) were men. Peak oxygen consumption (14.1 ± 4.1 ml/kg/min) and %ppVO2 (68.4 ± 18.8%) were blunted. Twenty-seven (36%) patients had an abnormal pressure response to exercise. After a median follow-up of 25 (12-31) months, the composite outcome of death or heart failure hospitalization was registered in 19 (25.3%) patients. At univariate analysis %ppVO2 was a stronger predictor for the composite outcome than peak VO2. %ppVO2 and NT-proBNP remained associated with the composite outcome at multivariate analysis. The optimal predictive threshold for %ppVO2 was 62% (sensitivity: 71%; specificity: 68%; AUC: 0.77, CI 0.65-0.88). Patients with %ppVO2 ≤ 62%and NT-proBNP > 3000 pg had a worse prognosis with 1- and 2-year survival of 69 ± 9% and 50 ± 10%, respectively. CPET is a safe and useful prognostic tool in patients with ATTR-CA. CPET may help to identify patients with advanced disease that may benefit from targeted therapy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a CPET | |
| 650 | 4 | |a Cardiac amyloidosis | |
| 650 | 4 | |a Predicted V02 | |
| 650 | 4 | |a Transthyretin amyloidosis | |
| 650 | 7 | |a Prealbumin |2 NLM | |
| 700 | 1 | |a Argirò, Alessia |e verfasserin |4 aut | |
| 700 | 1 | |a Baldasseroni, Samuele |e verfasserin |4 aut | |
| 700 | 1 | |a Fumagalli, Carlo |e verfasserin |4 aut | |
| 700 | 1 | |a Zampieri, Mattia |e verfasserin |4 aut | |
| 700 | 1 | |a Guerrieri, Ludovica |e verfasserin |4 aut | |
| 700 | 1 | |a Bartolini, Simone |e verfasserin |4 aut | |
| 700 | 1 | |a Mazzoni, Carlotta |e verfasserin |4 aut | |
| 700 | 1 | |a Burgisser, Costanza |e verfasserin |4 aut | |
| 700 | 1 | |a Tomberli, Alessia |e verfasserin |4 aut | |
| 700 | 1 | |a Di Mario, Carlo |e verfasserin |4 aut | |
| 700 | 1 | |a Marchionni, Niccolò |e verfasserin |4 aut | |
| 700 | 1 | |a Olivotto, Iacopo |e verfasserin |4 aut | |
| 700 | 1 | |a Perfetto, Federico |e verfasserin |4 aut | |
| 700 | 1 | |a Fattirolli, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Cappelli, Francesco |e verfasserin |4 aut | |
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