Affiliation:
1. Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens , Vassilisis Sofias 80 , Athens 11528, Greece
Abstract
Abstract
Aims
Complete haematologic response to treatment for light chain cardiac amyloidosis (AL-CA) may lead to improvement of myocardial function and better outcomes. We sought to evaluate the effect of response to treatment for AL-CA on echocardiographic indices of myocardial deformation and work and their prognostic significance.
Methods and results
Sixty-one patients treated for AL were enrolled and underwent echocardiographic assessment at baseline and at 1 year. Patients were stratified according to haematologic response as complete or not complete responders. A significant reduction in median N-terminal pro-brain natriuretic peptide (NT-proBNP) (2771–1486 pg/mL; P < 0.001) and posterior wall thickness (13–12 mm; P = 0.002) and an increase in global work index (GWI) (1115–1356 mmHg%; P = 0.018) was observed at 1 year. Patients with complete response (CR) had a more pronounced decrease in intraventricular septum thickness (14.2–12.0 mm; P = 0.006), improved global longitudinal strain (GLS) (−11.6 to −13.1%; P for interaction = 0.045), increased global constructive work (1245–1436 mmHg%; P = 0.008), and GWI (926–1250 mmHg%, P = 0.002) compared with non-CR. Furthermore, deltaGLS (ρspearman = 0.35; P < 0.001) and deltaGWI (ρspearman = −0.32; P = 0.02) correlated with delta NT-proBNP. Importantly, patients with GLS and GWI response had a better prognosis (log-rank P = 0.048 and log-rank P = 0.007, respectively). After adjustment for Mayo stage, gender, and response status, deltaGLS [hazard ratio (HR) = 1.404, P = 0.046 per 1% increase] and deltaGWI (HR = 0.996, P = 0.042 per 1mmHg% increase) were independent predictors of survival.
Conclusion
Complete haematologic response to treatment is associated with improved left ventricular myocardial work indices, and their change is associated with improved survival in AL-CA.
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine