Author + information
- Adil Yunis,
- Gheorghe Doros,
- Ivan Luptak,
- Lawreen Connors and
- Flora Sam
Background: Wild-type transthyretin amyloidosis (ATTRwt) results in a progressive cardiomyopathy (CMY). The utility of cardiopulmonary exercise testing (CPX) in determining prognosis in ATTRwt CMY is unknown. Given the recent emergence of novel drug therapies to treat ATTRwt, we investigated the prognostic value of VE/VCO2 and peak VO2 by CPX on mortality in a cohort of ATTRwt CMY patients.
Methods: Between 2005-2015, of 121 patients with biopsy and immunohistochemically proven ATTRwt, 56 were prospectively evaluated with CPX as part of a NIH ATTRwt substudy at the Boston University Amyloidosis Center.
Results: The patients were all male, predominantly white (69.9%) and elderly (75±6yrs). Univariate Cox regression analysis showed VE/VCO2 slope and peak VO2 were significant predictors of mortality (P<0.05). Area under the ROC curve was greatest for VE/VCO2 slope (Figure 1). Diabetes, OSA, BP, LVEF, BNP, CRP, sodium, creatinine and A-velocity were also independent predictors of mortality by univariate analysis. Only CRP [HR 1.10 (1.03-1.18)], sodium [HR 0.77 (0.59-1.01)], creatinine [HR 7.95 (2.13-29.63)] and VE/VCO2 [HR 1.13 (1.05-1.22)] were predictors of mortality by multivariate analysis (P<0.05). Peak VO2, a traditional prognostic marker in non-amyloid CMY, was insignificant in this model.
Conclusions: VE/VCO2 slope is a powerful predictor of mortality in ATTRwt and demonstrates enhanced prognosis in a model that includes CRP, sodium and creatinine. VE/VCO2 may be used to gauge therapy response.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in HCM, PPCM and Other Cardiomyopathies
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1201-269
- 2017 American College of Cardiology Foundation