eprintid: 10127968 rev_number: 30 eprint_status: archive userid: 608 dir: disk0/10/12/79/68 datestamp: 2021-05-18 14:43:04 lastmod: 2021-09-20 22:37:30 status_changed: 2021-05-18 14:43:04 type: article metadata_visibility: show creators_name: Law, S creators_name: Petrie, A creators_name: Chacko, L creators_name: Cohen, OC creators_name: Ravichandran, S creators_name: Gilbertson, JA creators_name: Rowczenio, D creators_name: Wechalekar, AD creators_name: Martinez-Naharro, A creators_name: Lachmann, HJ creators_name: Whelan, CJ creators_name: Hutt, DF creators_name: Hawkins, PN creators_name: Fontana, M creators_name: Gillmore, JD title: Change in N-terminal pro-B-type natriuretic peptide at 1 year predicts mortality in wild-type transthyretin amyloid cardiomyopathy ispublished: inpress divisions: UCL divisions: B02 divisions: C10 divisions: D17 divisions: G90 divisions: D21 keywords: biomarkers, cardiomyopathies, heart failure note: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. abstract: OBJECTIVES: Wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) is a progressive and fatal condition. Although prognosis can be determined at the time of diagnosis according to National Amyloidosis Centre (NAC) transthyretin amyloidosis (ATTR) stage, the clinical course varies substantially between individuals. There are currently no established measures of rate of disease progression. Through systematic analysis of functional, biochemical and echocardiographic disease-related variables we aimed to identify prognostic markers of disease progression in wtATTR-CM. METHODS: This is a retrospective observational study of 432 patients with wtATTR-CM diagnosed at the UK NAC, none of whom received disease-modifying therapy. The association between mortality from the 12-month timepoint and change from diagnosis to 12 months in a variety of disease-related variables was explored using Cox regression. RESULTS: Change in N-terminal pro-B-type natriuretic peptide concentration (∆ NT-proBNP) at 12 months from diagnosis was the strongest predictor of ongoing mortality and was independent of both change in other disease-related variables (HR 1.04 per 500 ng/L increase (95% CI 1.01 to 1.07); p=0.003) and a range of known prognostic variables at the time of diagnosis (HR 1.07 per 500 ng/L increase (95% CI 1.02 to 1.13); p=0.007). An increase in NT-proBNP of >500 ng/L, >1000 ng/L and >2000 ng/L during the first year of follow-up occurred in 45%, 35% and 16% of patients, respectively. CONCLUSION: Change in NT-proBNP concentration during the first year of follow-up is a powerful independent predictor of mortality in wtATTR-CM. date: 2021-05-14 date_type: published official_url: http://dx.doi.org/10.1136/heartjnl-2021-319063 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1865060 doi: 10.1136/heartjnl-2021-319063 pii: heartjnl-2021-319063 lyricists_name: Chacko, Liza lyricists_name: Cohen, Oliver lyricists_name: Fontana, Marianna lyricists_name: Gilbertson, Janet lyricists_name: Gillmore, Julian lyricists_name: Hawkins, Philip lyricists_name: Lachmann, Helen lyricists_name: Law, Steven lyricists_name: Petrie, Aviva lyricists_name: Ravichandran, Sriram lyricists_name: Wechalekar, Ashutosh lyricists_id: LACHA03 lyricists_id: OCOHE36 lyricists_id: MFONT56 lyricists_id: JAGIL44 lyricists_id: JGILL78 lyricists_id: PNHAW77 lyricists_id: HJLAC80 lyricists_id: SLAWX91 lyricists_id: APETR26 lyricists_id: SNRAV92 lyricists_id: AWECH53 actors_name: Dewerpe, Marie actors_id: MDDEW97 actors_role: owner full_text_status: public publication: Heart event_location: England citation: Law, S; Petrie, A; Chacko, L; Cohen, OC; Ravichandran, S; Gilbertson, JA; Rowczenio, D; ... Gillmore, JD; + view all <#> Law, S; Petrie, A; Chacko, L; Cohen, OC; Ravichandran, S; Gilbertson, JA; Rowczenio, D; Wechalekar, AD; Martinez-Naharro, A; Lachmann, HJ; Whelan, CJ; Hutt, DF; Hawkins, PN; Fontana, M; Gillmore, JD; - view fewer <#> (2021) Change in N-terminal pro-B-type natriuretic peptide at 1 year predicts mortality in wild-type transthyretin amyloid cardiomyopathy. Heart 10.1136/heartjnl-2021-319063 <https://doi.org/10.1136/heartjnl-2021-319063>. (In press). Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10127968/1/Law_heartjnl-2021-319063.full.pdf