Abstract
Background Although patients with immunoglobulin light chain (AL) cardiac amyloidosis exhibit worse outcomes than those with transthyretin (TTR) cardiac amyloidosis, few data exist regarding the occurrence of cardiac events and the echocardiographic indices in endomyocardial biopsy (EMBx) proven amyloidosis.
Methods From November 2007 to October 2012, we identified 33 patients with EMBx-proven amyloidosis. There were 12 patients (8 men; mean age: 66 years) with AL and 21 patients (20 men; mean age: 78 years) with TTR. We performed serial echocardiography and observed the patients during follow-up; defining all-cause mortality as the primary endpoint and hospitalization for heart failure as the secondary endpoint.
Results The survival rates at 12 months were 20.8% and 85.7% in AL and TTR, respectively (p < 0.001). The cumulative incidences of the composite of death or readmission for heart failure at 12 months were 91.7% and 51.3% in AL and TTR, respectively (p < 0.001). A multivariate analysis showed that the AL type amyloid was the powerful predictor of mortality (hazard ratio: 8.50, 95% confidence interval: 1.79 to 40.57, p < 0.05). Under these conditions, the E/e′ in AL tended to increase from 23 ± 13 to 28 ± 11 (p = 0.06) with marked increases in B-type natriuretic peptide (779 ± 456 pg/ml to 1576 ± 895 pg/ml, p < 0.05), although these remained unchanged in TTR, which exhibited significantly increased left ventricular end-diastolic dimensions from 40 ± 4 mm to 42 ± 4 mm (p < 0.05).
Conclusions The survival rate was generally worse in AL cardiac amyloidosis, although the readmission for heart failure remains high in TTR cardiac amyloidosis with the occurrence of left ventricular dilatation.
| Original language | English |
|---|---|
| Pages (from-to) | 753-759 |
| Number of pages | 7 |
| Journal | International Journal of Cardiology |
| Volume | 176 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Oct 20 2014 |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
Cite this
Impact of clinical and echocardiographic characteristics on occurrence of cardiac events in cardiac amyloidosis as proven by endomyocardial biopsy. / Nakahashi, Takuya; Arita, Takeshi; Yamaji, Kyohei; Inoue, Katsumi; Yokota, Tadaaki; Hoshii, Yoshinobu; Fukunaga, Masato; Nomura, Akihiro; Watanabe, Hirotoshi; Miura, Shirou; Isotani, Akihiro; Soga, Yoshimitsu; Ando, Kenji; Iwabuchi, Masashi; Yokoi, Hiroyoshi; Nosaka, Hideyuki; Yamagishi, Masakazu; Nobuyoshi, Masakiyo.
In: International Journal of Cardiology, Vol. 176, No. 3, 20.10.2014, p. 753-759.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Impact of clinical and echocardiographic characteristics on occurrence of cardiac events in cardiac amyloidosis as proven by endomyocardial biopsy
AU - Nakahashi, Takuya
AU - Arita, Takeshi
AU - Yamaji, Kyohei
AU - Inoue, Katsumi
AU - Yokota, Tadaaki
AU - Hoshii, Yoshinobu
AU - Fukunaga, Masato
AU - Nomura, Akihiro
AU - Watanabe, Hirotoshi
AU - Miura, Shirou
AU - Isotani, Akihiro
AU - Soga, Yoshimitsu
AU - Ando, Kenji
AU - Iwabuchi, Masashi
AU - Yokoi, Hiroyoshi
AU - Nosaka, Hideyuki
AU - Yamagishi, Masakazu
AU - Nobuyoshi, Masakiyo
PY - 2014/10/20
Y1 - 2014/10/20
N2 - Background Although patients with immunoglobulin light chain (AL) cardiac amyloidosis exhibit worse outcomes than those with transthyretin (TTR) cardiac amyloidosis, few data exist regarding the occurrence of cardiac events and the echocardiographic indices in endomyocardial biopsy (EMBx) proven amyloidosis.Methods From November 2007 to October 2012, we identified 33 patients with EMBx-proven amyloidosis. There were 12 patients (8 men; mean age: 66 years) with AL and 21 patients (20 men; mean age: 78 years) with TTR. We performed serial echocardiography and observed the patients during follow-up; defining all-cause mortality as the primary endpoint and hospitalization for heart failure as the secondary endpoint.Results The survival rates at 12 months were 20.8% and 85.7% in AL and TTR, respectively (p < 0.001). The cumulative incidences of the composite of death or readmission for heart failure at 12 months were 91.7% and 51.3% in AL and TTR, respectively (p < 0.001). A multivariate analysis showed that the AL type amyloid was the powerful predictor of mortality (hazard ratio: 8.50, 95% confidence interval: 1.79 to 40.57, p < 0.05). Under these conditions, the E/e′ in AL tended to increase from 23 ± 13 to 28 ± 11 (p = 0.06) with marked increases in B-type natriuretic peptide (779 ± 456 pg/ml to 1576 ± 895 pg/ml, p < 0.05), although these remained unchanged in TTR, which exhibited significantly increased left ventricular end-diastolic dimensions from 40 ± 4 mm to 42 ± 4 mm (p < 0.05).Conclusions The survival rate was generally worse in AL cardiac amyloidosis, although the readmission for heart failure remains high in TTR cardiac amyloidosis with the occurrence of left ventricular dilatation.
AB - Background Although patients with immunoglobulin light chain (AL) cardiac amyloidosis exhibit worse outcomes than those with transthyretin (TTR) cardiac amyloidosis, few data exist regarding the occurrence of cardiac events and the echocardiographic indices in endomyocardial biopsy (EMBx) proven amyloidosis.Methods From November 2007 to October 2012, we identified 33 patients with EMBx-proven amyloidosis. There were 12 patients (8 men; mean age: 66 years) with AL and 21 patients (20 men; mean age: 78 years) with TTR. We performed serial echocardiography and observed the patients during follow-up; defining all-cause mortality as the primary endpoint and hospitalization for heart failure as the secondary endpoint.Results The survival rates at 12 months were 20.8% and 85.7% in AL and TTR, respectively (p < 0.001). The cumulative incidences of the composite of death or readmission for heart failure at 12 months were 91.7% and 51.3% in AL and TTR, respectively (p < 0.001). A multivariate analysis showed that the AL type amyloid was the powerful predictor of mortality (hazard ratio: 8.50, 95% confidence interval: 1.79 to 40.57, p < 0.05). Under these conditions, the E/e′ in AL tended to increase from 23 ± 13 to 28 ± 11 (p = 0.06) with marked increases in B-type natriuretic peptide (779 ± 456 pg/ml to 1576 ± 895 pg/ml, p < 0.05), although these remained unchanged in TTR, which exhibited significantly increased left ventricular end-diastolic dimensions from 40 ± 4 mm to 42 ± 4 mm (p < 0.05).Conclusions The survival rate was generally worse in AL cardiac amyloidosis, although the readmission for heart failure remains high in TTR cardiac amyloidosis with the occurrence of left ventricular dilatation.
UR - http://www.scopus.com/inward/record.url?scp=84908231988&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84908231988&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2014.07.100
DO - 10.1016/j.ijcard.2014.07.100
M3 - Article
C2 - 25131905
AN - SCOPUS:84908231988
VL - 176
SP - 753
EP - 759
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 3
ER -