Hemodynamic Profiling and Prognosis in Cardiac Amyloidosis
Little information is available on the prognostic relevance of cardiac hemodynamic cutoffs in cardiac amyloidosis (CA) and its subtypes. Consecutive patients diagnose with light chain-CA or transthyretin CA undergoing right heart catheterization were analyzed. Prognostic relevance of classic hemodyn...
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| Veröffentlicht in: | Circulation. Heart failure 2023-03, Vol.16 (3), p.e010078-e010078 |
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| creator | Martens, Pieter Bhattacharya, Sanjeeb Longinow, Joshua Ives, Lauren Jacob, Miriam Valent, Jason Hanna, Mazen Tang, W.H. Wilson |
| description | Little information is available on the prognostic relevance of cardiac hemodynamic cutoffs in cardiac amyloidosis (CA) and its subtypes.
Consecutive patients diagnose with light chain-CA or transthyretin CA undergoing right heart catheterization were analyzed. Prognostic relevance of classic hemodynamic cutoffs of cardiac index (CI 18 mm Hg), right atrial pressure (>8 mm Hg), and mean pulmonary artery pressure (≥25 mm Hg or pulmonary hypertension) with the combined end point of cardiac transplant/left ventricular assist device and death and heart failure admissions separately was assessed.
A total of 469 CA patients underwent right heart catheterization (light chain CA=42% and transthyretin CA=52%) of whom 69%, 64%, and 79% had elevated right atrial pressure, pulmonary capillary wedge pressure, and pulmonary hypertension, respectively. The classic hemodynamic cutoffs for right atrial pressure (hazard ratio, 1.26 [0.98-1.62]) and mean pulmonary artery pressure (hazard ratio, 1.28 [0.96-1.71]) did not identify patients at higher risk for adverse outcome; however, cutoffs of 14 mm Hg for right atrial pressure (hazard ratio, 1.59 [1.26-2.00]) and 35 mm Hg for mean pulmonary artery pressure (hazard ratio, 1.30 [1.01-1.66]) performed better to detect worse outcome ( |
| doi_str_mv | 10.1161/CIRCHEARTFAILURE.122.010078 |
| format | Article |
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Consecutive patients diagnose with light chain-CA or transthyretin CA undergoing right heart catheterization were analyzed. Prognostic relevance of classic hemodynamic cutoffs of cardiac index (CI <2.2 L/min per m
), pulmonary capillary wedge pressure (>18 mm Hg), right atrial pressure (>8 mm Hg), and mean pulmonary artery pressure (≥25 mm Hg or pulmonary hypertension) with the combined end point of cardiac transplant/left ventricular assist device and death and heart failure admissions separately was assessed.
A total of 469 CA patients underwent right heart catheterization (light chain CA=42% and transthyretin CA=52%) of whom 69%, 64%, and 79% had elevated right atrial pressure, pulmonary capillary wedge pressure, and pulmonary hypertension, respectively. The classic hemodynamic cutoffs for right atrial pressure (hazard ratio, 1.26 [0.98-1.62]) and mean pulmonary artery pressure (hazard ratio, 1.28 [0.96-1.71]) did not identify patients at higher risk for adverse outcome; however, cutoffs of 14 mm Hg for right atrial pressure (hazard ratio, 1.59 [1.26-2.00]) and 35 mm Hg for mean pulmonary artery pressure (hazard ratio, 1.30 [1.01-1.66]) performed better to detect worse outcome (
<0.05 for both). Reduced CI occurred in 55% of patients and was the strongest variable associated with the risk for cardiac transplant/left ventricular assist device and death, heart failure admissions, and reduced functional capacity. Reduced CI independently predicted risk on top of the Mayo-score in light chain CA and National Amyloid Center score in transthyretin CA (
<0.05 for both). Patients with light chain CA had higher pulmonary capillary wedge pressure and lower stroke volume index but maintained CI through a higher heart rate.
Hemodynamic variables are grossly abnormal in CA, but elevated filling pressures are prognostic at significantly higher threshold values than classic cutoff values. CI is the hemodynamic variable most strongly associated with outcome and functionality in CA.</description><identifier>ISSN: 1941-3297</identifier><identifier>ISSN: 1941-3289</identifier><identifier>EISSN: 1941-3297</identifier><identifier>DOI: 10.1161/CIRCHEARTFAILURE.122.010078</identifier><identifier>PMID: 36695180</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Amyloidosis - diagnosis ; Cardiac Catheterization ; Heart Failure - diagnosis ; Hemodynamics - physiology ; Humans ; Hypertension, Pulmonary ; Prealbumin ; Prognosis ; Pulmonary Wedge Pressure - physiology</subject><ispartof>Circulation. Heart failure, 2023-03, Vol.16 (3), p.e010078-e010078</ispartof><rights>Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4196-6a86e5003c5a2ee821aeb6ddcf194d44b1dc43434d32b291cf9385970aa893b63</citedby><cites>FETCH-LOGICAL-c4196-6a86e5003c5a2ee821aeb6ddcf194d44b1dc43434d32b291cf9385970aa893b63</cites><orcidid>0000-0002-6826-4665 ; 0000-0002-8335-735X ; 0000-0002-3547-878X ; 0000-0001-5671-9557 ; 0000-0002-6036-2113 ; 0000-0002-2529-7467</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36695180$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Martens, Pieter</creatorcontrib><creatorcontrib>Bhattacharya, Sanjeeb</creatorcontrib><creatorcontrib>Longinow, Joshua</creatorcontrib><creatorcontrib>Ives, Lauren</creatorcontrib><creatorcontrib>Jacob, Miriam</creatorcontrib><creatorcontrib>Valent, Jason</creatorcontrib><creatorcontrib>Hanna, Mazen</creatorcontrib><creatorcontrib>Tang, W.H. Wilson</creatorcontrib><title>Hemodynamic Profiling and Prognosis in Cardiac Amyloidosis</title><title>Circulation. Heart failure</title><addtitle>Circ Heart Fail</addtitle><description>Little information is available on the prognostic relevance of cardiac hemodynamic cutoffs in cardiac amyloidosis (CA) and its subtypes.
Consecutive patients diagnose with light chain-CA or transthyretin CA undergoing right heart catheterization were analyzed. Prognostic relevance of classic hemodynamic cutoffs of cardiac index (CI <2.2 L/min per m
), pulmonary capillary wedge pressure (>18 mm Hg), right atrial pressure (>8 mm Hg), and mean pulmonary artery pressure (≥25 mm Hg or pulmonary hypertension) with the combined end point of cardiac transplant/left ventricular assist device and death and heart failure admissions separately was assessed.
A total of 469 CA patients underwent right heart catheterization (light chain CA=42% and transthyretin CA=52%) of whom 69%, 64%, and 79% had elevated right atrial pressure, pulmonary capillary wedge pressure, and pulmonary hypertension, respectively. The classic hemodynamic cutoffs for right atrial pressure (hazard ratio, 1.26 [0.98-1.62]) and mean pulmonary artery pressure (hazard ratio, 1.28 [0.96-1.71]) did not identify patients at higher risk for adverse outcome; however, cutoffs of 14 mm Hg for right atrial pressure (hazard ratio, 1.59 [1.26-2.00]) and 35 mm Hg for mean pulmonary artery pressure (hazard ratio, 1.30 [1.01-1.66]) performed better to detect worse outcome (
<0.05 for both). Reduced CI occurred in 55% of patients and was the strongest variable associated with the risk for cardiac transplant/left ventricular assist device and death, heart failure admissions, and reduced functional capacity. Reduced CI independently predicted risk on top of the Mayo-score in light chain CA and National Amyloid Center score in transthyretin CA (
<0.05 for both). Patients with light chain CA had higher pulmonary capillary wedge pressure and lower stroke volume index but maintained CI through a higher heart rate.
Hemodynamic variables are grossly abnormal in CA, but elevated filling pressures are prognostic at significantly higher threshold values than classic cutoff values. CI is the hemodynamic variable most strongly associated with outcome and functionality in CA.</description><subject>Amyloidosis - diagnosis</subject><subject>Cardiac Catheterization</subject><subject>Heart Failure - diagnosis</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Hypertension, Pulmonary</subject><subject>Prealbumin</subject><subject>Prognosis</subject><subject>Pulmonary Wedge Pressure - physiology</subject><issn>1941-3297</issn><issn>1941-3289</issn><issn>1941-3297</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkF1LwzAUhoMoTqd_QQreeNN5krRpo1ejbG4wUMZ2HdIk3aL9mMnG2L83YyoiIeTk8L7n40HoHsMAY4Yfi-m8mIyG88V4OJ0t56MBJmQAGCDLz9AV5gmOKeHZ-Z-4h669fwdgJE35JepRxniKc7hCTxPTdPrQysaq6M11la1tu4pkq4-_Vdt56yPbRoV02koVDZtD3Vl9TN-gi0rW3tx-v320HI8WxSSevb5Mi-EsVgnmLGYyZyYFoCqVxJicYGlKprWqwng6SUqsVULD0ZSUhGNVcZqnPAMpc05LRvvo4VR347rPnfFb0VivTF3L1nQ7L0gWluGEcgjS55NUuc57ZyqxcbaR7iAwiCM88R-eCPDECV5w33032pWN0b_eH1pBkJwE-67eGuc_6t3eOLE2st6uQxVKs4QnMQFCgQJAHC4w-gUwj3ue</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Martens, Pieter</creator><creator>Bhattacharya, Sanjeeb</creator><creator>Longinow, Joshua</creator><creator>Ives, Lauren</creator><creator>Jacob, Miriam</creator><creator>Valent, Jason</creator><creator>Hanna, Mazen</creator><creator>Tang, W.H. Wilson</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6826-4665</orcidid><orcidid>https://orcid.org/0000-0002-8335-735X</orcidid><orcidid>https://orcid.org/0000-0002-3547-878X</orcidid><orcidid>https://orcid.org/0000-0001-5671-9557</orcidid><orcidid>https://orcid.org/0000-0002-6036-2113</orcidid><orcidid>https://orcid.org/0000-0002-2529-7467</orcidid></search><sort><creationdate>20230301</creationdate><title>Hemodynamic Profiling and Prognosis in Cardiac Amyloidosis</title><author>Martens, Pieter ; Bhattacharya, Sanjeeb ; Longinow, Joshua ; Ives, Lauren ; Jacob, Miriam ; Valent, Jason ; Hanna, Mazen ; Tang, W.H. Wilson</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4196-6a86e5003c5a2ee821aeb6ddcf194d44b1dc43434d32b291cf9385970aa893b63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Amyloidosis - diagnosis</topic><topic>Cardiac Catheterization</topic><topic>Heart Failure - diagnosis</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Hypertension, Pulmonary</topic><topic>Prealbumin</topic><topic>Prognosis</topic><topic>Pulmonary Wedge Pressure - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Martens, Pieter</creatorcontrib><creatorcontrib>Bhattacharya, Sanjeeb</creatorcontrib><creatorcontrib>Longinow, Joshua</creatorcontrib><creatorcontrib>Ives, Lauren</creatorcontrib><creatorcontrib>Jacob, Miriam</creatorcontrib><creatorcontrib>Valent, Jason</creatorcontrib><creatorcontrib>Hanna, Mazen</creatorcontrib><creatorcontrib>Tang, W.H. Wilson</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Martens, Pieter</au><au>Bhattacharya, Sanjeeb</au><au>Longinow, Joshua</au><au>Ives, Lauren</au><au>Jacob, Miriam</au><au>Valent, Jason</au><au>Hanna, Mazen</au><au>Tang, W.H. Wilson</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemodynamic Profiling and Prognosis in Cardiac Amyloidosis</atitle><jtitle>Circulation. Heart failure</jtitle><addtitle>Circ Heart Fail</addtitle><date>2023-03-01</date><risdate>2023</risdate><volume>16</volume><issue>3</issue><spage>e010078</spage><epage>e010078</epage><pages>e010078-e010078</pages><issn>1941-3297</issn><issn>1941-3289</issn><eissn>1941-3297</eissn><abstract>Little information is available on the prognostic relevance of cardiac hemodynamic cutoffs in cardiac amyloidosis (CA) and its subtypes.
Consecutive patients diagnose with light chain-CA or transthyretin CA undergoing right heart catheterization were analyzed. Prognostic relevance of classic hemodynamic cutoffs of cardiac index (CI <2.2 L/min per m
), pulmonary capillary wedge pressure (>18 mm Hg), right atrial pressure (>8 mm Hg), and mean pulmonary artery pressure (≥25 mm Hg or pulmonary hypertension) with the combined end point of cardiac transplant/left ventricular assist device and death and heart failure admissions separately was assessed.
A total of 469 CA patients underwent right heart catheterization (light chain CA=42% and transthyretin CA=52%) of whom 69%, 64%, and 79% had elevated right atrial pressure, pulmonary capillary wedge pressure, and pulmonary hypertension, respectively. The classic hemodynamic cutoffs for right atrial pressure (hazard ratio, 1.26 [0.98-1.62]) and mean pulmonary artery pressure (hazard ratio, 1.28 [0.96-1.71]) did not identify patients at higher risk for adverse outcome; however, cutoffs of 14 mm Hg for right atrial pressure (hazard ratio, 1.59 [1.26-2.00]) and 35 mm Hg for mean pulmonary artery pressure (hazard ratio, 1.30 [1.01-1.66]) performed better to detect worse outcome (
<0.05 for both). Reduced CI occurred in 55% of patients and was the strongest variable associated with the risk for cardiac transplant/left ventricular assist device and death, heart failure admissions, and reduced functional capacity. Reduced CI independently predicted risk on top of the Mayo-score in light chain CA and National Amyloid Center score in transthyretin CA (
<0.05 for both). Patients with light chain CA had higher pulmonary capillary wedge pressure and lower stroke volume index but maintained CI through a higher heart rate.
Hemodynamic variables are grossly abnormal in CA, but elevated filling pressures are prognostic at significantly higher threshold values than classic cutoff values. CI is the hemodynamic variable most strongly associated with outcome and functionality in CA.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>36695180</pmid><doi>10.1161/CIRCHEARTFAILURE.122.010078</doi><orcidid>https://orcid.org/0000-0002-6826-4665</orcidid><orcidid>https://orcid.org/0000-0002-8335-735X</orcidid><orcidid>https://orcid.org/0000-0002-3547-878X</orcidid><orcidid>https://orcid.org/0000-0001-5671-9557</orcidid><orcidid>https://orcid.org/0000-0002-6036-2113</orcidid><orcidid>https://orcid.org/0000-0002-2529-7467</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1941-3297 |
| ispartof | Circulation. Heart failure, 2023-03, Vol.16 (3), p.e010078-e010078 |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Amyloidosis - diagnosis Cardiac Catheterization Heart Failure - diagnosis Hemodynamics - physiology Humans Hypertension, Pulmonary Prealbumin Prognosis Pulmonary Wedge Pressure - physiology |
| title | Hemodynamic Profiling and Prognosis in Cardiac Amyloidosis |
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