Ioannou, Adam;
Rauf, Muhammad U;
Patel, Rishi K;
Razvi, Yousuf;
Porcari, Aldostefano;
Martinez-Naharro, Ana;
Venneri, Lucia;
... Fontana, Marianna; + view all
(2023)
Albuminuria in cardiac ATTR amyloidosis: prevalence, progression and prognostic importance.
European Journal of Heart Failure
10.1002/ejhf.3094.
(In press).
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European J of Heart Fail - 2023 - Ioannou - Albuminuria in transthyretin cardiac amyloidosis Prevalence progression and.pdf Download (1MB) | Preview |
Abstract
AIMS: Transthyretin cardiac amyloidosis (ATTR-CA) is an infiltrative cardiomyopathy that commonly presents with concomitant chronic kidney disease. Albuminuria is common in heart failure and associated with worse outcomes, but its prevalence and relationship to outcome in ATTR-CA remains unclear. METHODS AND RESULTS: A total of 1181 patients with ATTR-CA were studied (mean age 78.1±7.9 years; 1022[86.5%] male; median eGFR 59ml/min/1.73m2 [IQR: 47-74]). Albuminuria was present in 563(47.7%) patients (499[88.6%] with microalbuminuria and 64[11.4%] with macroalbuminuria). Patients with albuminuria had a more severe cardiac phenotype evidenced by higher serum cardiac biomarkers (median NT-proBNP: 4027ng/L [2173-6889] vs 1851ng/L [997-3209], P<0.001; median troponin-T: 69ng/L [46-101] vs 48ng/L [34-68], P<0.001) and worse echocardiographic indices of systolic (longitudinal strain: -10.0±3.6% vs -11.6±3.8, P<0.001) and diastolic function (E/e': 17.5±6.4 vs 16.4±6.7, P<0.001) than those with a normal UACR. Microalbuminuria and macroalbuminuria were independently associated with mortality in the overall population (HR=1.47, 95%CI[1.13-1.92], P=0.005 and HR=1.87, 95%CI[1.15-3.05], P=0.012, respectively). In a subgroup of patients (n = 349) without concomitant hypertension, diabetes mellitus or chronic kidney disease, albuminuria was also associated with mortality (HR=2.98, 95%CI[1.72-5.17], P<0.001). At 12 months, 330 patients had a repeat UACR measurement; those in whom UACR increased by 30% or more (n = 148, 44.8%) had an increased risk of mortality (HR=1.84, 95%CI[1.06-3.19], P=0.030). CONCLUSIONS: Albuminuria is common in patients with ATTR-CA, and more prevalent in those with a more severe cardiac phenotype. Albuminuria at diagnosis and a significant increase in UACR during follow up are associated with mortality. This article is protected by copyright. All rights reserved.
| Type: | Article |
|---|---|
| Title: | Albuminuria in cardiac ATTR amyloidosis: prevalence, progression and prognostic importance |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/ejhf.3094 |
| Publisher version: | https://doi.org/10.1002/ejhf.3094 |
| Language: | English |
| Additional information: | Copyright © 2023 The Authors. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10182542 |
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