© 2007 European Society of Cardiology
Non-invasive predictors of survival in cardiac amyloidosis
a Department of Cardiology, Angiology, and Respiratory Medicine, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
b Department of Haematology, Oncology, and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
c Department of Pathology, University of Heidelberg, Im Neuenheimer Feld 220, D-69120 Heidelberg, Germany
d Institute of Management in Healthcare and Welfare, Steinbeis University Berlin, Neufeldstr. 6, D-76456 Kuppenheim, Germany
* Corresponding author. Tel: +49 6221 568611; fax: +49 6221 565515. E-mail address: Thomas_Dengler{at}med.uni-heidelberg.de
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Abstract |
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Background: Patients with cardiac amyloidosis (CA) have increased mortality.
Aims: Clinical, electrocardiographic, and echocardiographic parameters were assessed for risk-stratification of CA.
Methods and results: CA was confirmed by endomyocardial biopsy in 59 patients (54.8±1.2 years) with light-chain (n = 43) or transthyretin amyloidosis (n = 16). Six patients without CA served as controls (NCA). Clinical symptoms, electrocardiographic, and echocardiographic parameters were analyzed for prognostic significance. Of the patients with light-chain amyloidosis, 14 died and 2 underwent heart transplantation. 1-/3-year survival was 68%/63%. Survival depended on left ventricular function (LV-EF), LV mass, radius/wall thickness, septum thickness, low voltage pattern (LVP), conduction delay, NYHA class, and stem cell transplantation. A multivariate model only contained LV-EF and LVP; the beneficial effect of stem cell transplantation was cancelled out as this treatment was withheld in patients with highest cardiac risk. Survival was most limited if both risk factors occurred. Cardiac involvement in transthyretin amyloidosis showed better survival (2 deaths, 1-/3-year survival 91%/83%). Analysis of prognostic risk factor utility in all amyloid patients (light-chain and transthyretin) again revealed LVP and LV-EF, and aetiology of amyloidosis as independent survival parameters.
Conclusion: Prognosis of CA is poor, but aetiology of amyloid, LVP, and LV-EF allows identification of patients at highest risk of death, who may require individual treatment approaches (heart transplantation prior to causative therapy).
Key Words: Cardiac amyloidosis • Echocardiography • Electrocardiography • Endomyocardial biopsy • Risk assessment • Survival
Received September 15, 2006; Revised December 2, 2006; Accepted January 31, 2007
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