Prevalence and clinical significance of right ventricular pulmonary arterial uncoupling in cardiac amyloidosis
Copyright © 2023 Elsevier B.V. All rights reserved..
BACKGROUND: This study aims to evaluate the prevalence and the clinical significance of the right ventricular pulmonary arterial (RV-PA) uncoupling in patients with cardiac amyloidosis (CA).
METHODS: The study population consisted in 92 consecutive patients with CA (age 71.1 ± 12.2 years, 71% males; 47% with immunoglobulin light chain (AL), 53% with transthyretin [ATTR]). A pre-specified tricuspid anulus plane systolic excursion on pulmonary arterial systolic pressure (TAPSE/PASP) value <0.31 mm/mmHg was used to define RV-PA uncoupling and to dichotomize the study population.
RESULTS: Thirty-two patients (35%) showed RV-PA uncoupling at baseline evaluation (15/44 [34%] AL and 17/48 [35%] ATTR). Patients with RV-PA uncoupling, in both AL and ATTR, showed worse NYHA functional class, lower systemic blood pressure, and more pronounced left ventricular and RV systolic dysfunction than those with RV-PA coupling. During a median follow-up of 8 months (IQR 4-13), 26 patients (28%) experienced cardiovascular death. Patients with RV-PA uncoupling showed lower survival at 12 months follow-up than those with RV-PA coupling (42.7% [95%CI 21.7-63.7%] vs. 87.3% [95%CI 78.3-96.3%], p-value<0.001). Multivariate analysis identified high-sensitivity troponin I values (HR 1.01 [95%CI 1.00-1.02] per 1 pg/mL increase; p-value 0.013) and TAPSE/PASP (HR 1.07 [95%CI 1.03-1.11] per 0.01 mm/mmHg decrease; p-value 0.002) as independent predictors of cardiovascular death.
CONCLUSIONS: RV-PA uncoupling is common among patient with CA, and it is a marker of advanced disease and worse outcome. This study suggest that TAPSE/PASP ratio has the potential to improve risk stratification and guide management strategies in patients with CA of different etiology and advanced disease.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:388 |
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| Enthalten in: |
International journal of cardiology - 388(2023) vom: 01. Okt., Seite 131147 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Palmiero, Giuseppe [VerfasserIn] |
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| Anmerkungen: |
Date Completed 14.08.2023 Date Revised 16.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ijcard.2023.131147 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM359246184 |
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| 041 | |a eng | ||
| 100 | 1 | |a Palmiero, Giuseppe |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prevalence and clinical significance of right ventricular pulmonary arterial uncoupling in cardiac amyloidosis |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 14.08.2023 | ||
| 500 | |a Date Revised 16.09.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier B.V. All rights reserved. | ||
| 520 | |a BACKGROUND: This study aims to evaluate the prevalence and the clinical significance of the right ventricular pulmonary arterial (RV-PA) uncoupling in patients with cardiac amyloidosis (CA) | ||
| 520 | |a METHODS: The study population consisted in 92 consecutive patients with CA (age 71.1 ± 12.2 years, 71% males; 47% with immunoglobulin light chain (AL), 53% with transthyretin [ATTR]). A pre-specified tricuspid anulus plane systolic excursion on pulmonary arterial systolic pressure (TAPSE/PASP) value <0.31 mm/mmHg was used to define RV-PA uncoupling and to dichotomize the study population | ||
| 520 | |a RESULTS: Thirty-two patients (35%) showed RV-PA uncoupling at baseline evaluation (15/44 [34%] AL and 17/48 [35%] ATTR). Patients with RV-PA uncoupling, in both AL and ATTR, showed worse NYHA functional class, lower systemic blood pressure, and more pronounced left ventricular and RV systolic dysfunction than those with RV-PA coupling. During a median follow-up of 8 months (IQR 4-13), 26 patients (28%) experienced cardiovascular death. Patients with RV-PA uncoupling showed lower survival at 12 months follow-up than those with RV-PA coupling (42.7% [95%CI 21.7-63.7%] vs. 87.3% [95%CI 78.3-96.3%], p-value<0.001). Multivariate analysis identified high-sensitivity troponin I values (HR 1.01 [95%CI 1.00-1.02] per 1 pg/mL increase; p-value 0.013) and TAPSE/PASP (HR 1.07 [95%CI 1.03-1.11] per 0.01 mm/mmHg decrease; p-value 0.002) as independent predictors of cardiovascular death | ||
| 520 | |a CONCLUSIONS: RV-PA uncoupling is common among patient with CA, and it is a marker of advanced disease and worse outcome. This study suggest that TAPSE/PASP ratio has the potential to improve risk stratification and guide management strategies in patients with CA of different etiology and advanced disease | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cardiac amyloidosis | |
| 650 | 4 | |a Echocardiography | |
| 650 | 4 | |a Outcome | |
| 700 | 1 | |a Monda, Emanuele |e verfasserin |4 aut | |
| 700 | 1 | |a Verrillo, Federica |e verfasserin |4 aut | |
| 700 | 1 | |a Dongiglio, Francesca |e verfasserin |4 aut | |
| 700 | 1 | |a Caiazza, Martina |e verfasserin |4 aut | |
| 700 | 1 | |a Rubino, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Lioncino, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Diana, Gaetano |e verfasserin |4 aut | |
| 700 | 1 | |a Vetrano, Erica |e verfasserin |4 aut | |
| 700 | 1 | |a Fusco, Adelaide |e verfasserin |4 aut | |
| 700 | 1 | |a Cirillo, Annapaola |e verfasserin |4 aut | |
| 700 | 1 | |a Mauriello, Alfredo |e verfasserin |4 aut | |
| 700 | 1 | |a Ciccarelli, Giovanni |e verfasserin |4 aut | |
| 700 | 1 | |a Ascione, Luigi |e verfasserin |4 aut | |
| 700 | 1 | |a De Rimini, Maria Luisa |e verfasserin |4 aut | |
| 700 | 1 | |a D'Alto, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Cerciello, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a D'Andrea, Antonello |e verfasserin |4 aut | |
| 700 | 1 | |a Golino, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Calabrò, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Bossone, Eduardo |e verfasserin |4 aut | |
| 700 | 1 | |a Limongelli, Giuseppe |e verfasserin |4 aut | |
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