Multiorgan Dysfunction and Associated Prognosis in Transthyretin Cardiac Amyloidosis
BACKGROUND: Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive and ultimately fatal cardiomyopathy. Biomarkers reflecting multiorgan dysfunction are of increasing importance in patients with heart failure; however, their significance in ATTR-CA remains largely unknown. The aims of this study were to characterize the multifaceted nature of ATTR-CA using blood biomarkers and assess the association between blood biomarkers and prognosis.
METHODS AND RESULTS: This is a retrospective cohort study of 2566 consecutive patients diagnosed with ATTR-CA between 2007 and 2023. Anemia (39%), high urea (52%), hyperbilirubinemia (18%), increased alkaline phosphatase (16%), increased CRP (C-reactive protein; 27%), and increased troponin (98.2%) were common findings in the overall population, whereas hyponatremia (6%) and hypoalbuminemia (2%) were less common. These abnormalities were most common in patients with p.(V142I) hereditary ATTR-CA, and became more prevalent as the severity of cardiac disease increased. Multivariable Cox regression analysis demonstrated that anemia (hazard ratio [HR], 1.19 [95% CI, 1.04-1.37]; P=0.01), high urea (HR, 1.23 [95% CI, 1.04-1.45]; P=0.01), hyperbilirubinemia (HR, 1.32 [95% CI, 1.13-1.57; P=0.001), increased alkaline phosphatase (HR, 1.20 [95% CI, 1.01-1.42; P=0.04), hyponatremia (HR, 1.65 [95% CI, 1.28-2.11]; P<0.001), and troponin-T >56 ng/L (HR, 1.72 [95% CI, 1.46-2.03]; P<0.001) were all independently associated with mortality in the overall population. The association between biomarkers and mortality varied across the spectrum of genotypes and left ventricular ejection fraction, with anemia remining independently associated with mortality in p.(V142I) hereditary ATTR-CA (HR, 1.58 [95% CI, 1.17-2.12]; P=0.003) and in a subgroup of the overall population with a left ventricular ejection fraction ≤40% (HR, 1.39 [95% CI, 1.08-1.81]; P=0.01).
CONCLUSIONS: Cardiac and noncardiac biomarker abnormalities were common and reflect the complex and multifaceted nature of ATTR-CA, with a wide range of biomarkers remaining independently associated with mortality. Clinical trials are needed to investigate whether biomarker abnormalities represent modifiable risk factors that if specifically targeted could improve outcomes.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
|---|---|
| Enthalten in: |
Journal of the American Heart Association - 13(2024), 4 vom: 20. Feb., Seite e033094 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Ioannou, Adam [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
8W8T17847W |
|---|
| Anmerkungen: |
Date Completed 21.02.2024 Date Revised 25.04.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1161/JAHA.123.033094 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM368037746 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM368037746 | ||
| 003 | DE-627 | ||
| 005 | 20240425232819.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240205s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1161/JAHA.123.033094 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1386.xml |
| 035 | |a (DE-627)NLM368037746 | ||
| 035 | |a (NLM)38314569 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Ioannou, Adam |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Multiorgan Dysfunction and Associated Prognosis in Transthyretin Cardiac Amyloidosis |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 21.02.2024 | ||
| 500 | |a Date Revised 25.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive and ultimately fatal cardiomyopathy. Biomarkers reflecting multiorgan dysfunction are of increasing importance in patients with heart failure; however, their significance in ATTR-CA remains largely unknown. The aims of this study were to characterize the multifaceted nature of ATTR-CA using blood biomarkers and assess the association between blood biomarkers and prognosis | ||
| 520 | |a METHODS AND RESULTS: This is a retrospective cohort study of 2566 consecutive patients diagnosed with ATTR-CA between 2007 and 2023. Anemia (39%), high urea (52%), hyperbilirubinemia (18%), increased alkaline phosphatase (16%), increased CRP (C-reactive protein; 27%), and increased troponin (98.2%) were common findings in the overall population, whereas hyponatremia (6%) and hypoalbuminemia (2%) were less common. These abnormalities were most common in patients with p.(V142I) hereditary ATTR-CA, and became more prevalent as the severity of cardiac disease increased. Multivariable Cox regression analysis demonstrated that anemia (hazard ratio [HR], 1.19 [95% CI, 1.04-1.37]; P=0.01), high urea (HR, 1.23 [95% CI, 1.04-1.45]; P=0.01), hyperbilirubinemia (HR, 1.32 [95% CI, 1.13-1.57; P=0.001), increased alkaline phosphatase (HR, 1.20 [95% CI, 1.01-1.42; P=0.04), hyponatremia (HR, 1.65 [95% CI, 1.28-2.11]; P<0.001), and troponin-T >56 ng/L (HR, 1.72 [95% CI, 1.46-2.03]; P<0.001) were all independently associated with mortality in the overall population. The association between biomarkers and mortality varied across the spectrum of genotypes and left ventricular ejection fraction, with anemia remining independently associated with mortality in p.(V142I) hereditary ATTR-CA (HR, 1.58 [95% CI, 1.17-2.12]; P=0.003) and in a subgroup of the overall population with a left ventricular ejection fraction ≤40% (HR, 1.39 [95% CI, 1.08-1.81]; P=0.01) | ||
| 520 | |a CONCLUSIONS: Cardiac and noncardiac biomarker abnormalities were common and reflect the complex and multifaceted nature of ATTR-CA, with a wide range of biomarkers remaining independently associated with mortality. Clinical trials are needed to investigate whether biomarker abnormalities represent modifiable risk factors that if specifically targeted could improve outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a blood biomarkers | |
| 650 | 4 | |a heart failure | |
| 650 | 4 | |a mortality | |
| 650 | 4 | |a transthyretin cardiac amyloidosis | |
| 650 | 7 | |a Prealbumin |2 NLM | |
| 650 | 7 | |a Alkaline Phosphatase |2 NLM | |
| 650 | 7 | |a EC 3.1.3.1 |2 NLM | |
| 650 | 7 | |a Biomarkers |2 NLM | |
| 650 | 7 | |a Urea |2 NLM | |
| 650 | 7 | |a 8W8T17847W |2 NLM | |
| 700 | 1 | |a Nitsche, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Porcari, Aldostefano |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Rishi K |e verfasserin |4 aut | |
| 700 | 1 | |a Razvi, Yousuf |e verfasserin |4 aut | |
| 700 | 1 | |a Rauf, Muhammad U |e verfasserin |4 aut | |
| 700 | 1 | |a Martinez-Naharro, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Venneri, Lucia |e verfasserin |4 aut | |
| 700 | 1 | |a Accietto, Antonella |e verfasserin |4 aut | |
| 700 | 1 | |a Netti, Lucrezia |e verfasserin |4 aut | |
| 700 | 1 | |a Bandera, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Virsinskaite, Ruta |e verfasserin |4 aut | |
| 700 | 1 | |a Kotecha, Tushar |e verfasserin |4 aut | |
| 700 | 1 | |a Knight, Dan |e verfasserin |4 aut | |
| 700 | 1 | |a Petrie, Aviva |e verfasserin |4 aut | |
| 700 | 1 | |a Whelan, Carol |e verfasserin |4 aut | |
| 700 | 1 | |a Wechalekar, Ashutosh |e verfasserin |4 aut | |
| 700 | 1 | |a Lachmann, Helen |e verfasserin |4 aut | |
| 700 | 1 | |a Hawkins, Philip N |e verfasserin |4 aut | |
| 700 | 1 | |a Gillmore, Julian D |e verfasserin |4 aut | |
| 700 | 1 | |a Fontana, Marianna |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of the American Heart Association |d 2012 |g 13(2024), 4 vom: 20. Feb., Seite e033094 |w (DE-627)NLM222412712 |x 2047-9980 |7 nnns |
| 773 | 1 | 8 | |g volume:13 |g year:2024 |g number:4 |g day:20 |g month:02 |g pages:e033094 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1161/JAHA.123.033094 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 13 |j 2024 |e 4 |b 20 |c 02 |h e033094 | ||