UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Multiorgan Dysfunction and Associated Prognosis in Transthyretin Cardiac Amyloidosis

Ioannou, Adam; Nitsche, Christian; Porcari, Aldostefano; Patel, Rishi K; Razvi, Yousuf; Rauf, Muhammad U; Martinez-Naharro, Ana; ... Fontana, Marianna; + view all (2024) Multiorgan Dysfunction and Associated Prognosis in Transthyretin Cardiac Amyloidosis. Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease , Article e033094. 10.1161/JAHA.123.033094. Green open access

[thumbnail of ioannou-et-al-2024-multiorgan-dysfunction-and-associated-prognosis-in-transthyretin-cardiac-amyloidosis.pdf]
Preview
PDF
ioannou-et-al-2024-multiorgan-dysfunction-and-associated-prognosis-in-transthyretin-cardiac-amyloidosis.pdf - Published Version

Download (2MB) | Preview

Abstract

BACKGROUND: Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive and ultimately fatal cardiomyopathy. Biomarkers reflecting multiorgan dysfunction are of increasing importance in patients with heart failure; however, their significance in ATTR-CA remains largely unknown. The aims of this study were to characterize the multifaceted nature of ATTR-CA using blood biomarkers and assess the association between blood biomarkers and prognosis. METHODS AND RESULTS: This is a retrospective cohort study of 2566 consecutive patients diagnosed with ATTR-CA between 2007 and 2023. Anemia (39%), high urea (52%), hyperbilirubinemia (18%), increased alkaline phosphatase (16%), increased CRP (C-reactive protein; 27%), and increased troponin (98.2%) were common findings in the overall population, whereas hyponatremia (6%) and hypoalbuminemia (2%) were less common. These abnormalities were most common in patients with p.(V142I) hereditary ATTR-CA, and became more prevalent as the severity of cardiac disease increased. Multivariable Cox regression analysis demonstrated that anemia (hazard ratio [HR], 1.19 [95% CI, 1.04-1.37]; P=0.01), high urea (HR, 1.23 [95% CI, 1.04-1.45]; P=0.01), hyperbilirubinemia (HR, 1.32 [95% CI, 1.13-1.57; P=0.001), increased alkaline phosphatase (HR, 1.20 [95% CI, 1.01-1.42; P=0.04), hyponatremia (HR, 1.65 [95% CI, 1.28-2.11]; P<0.001), and troponin-T >56 ng/L (HR, 1.72 [95% CI, 1.46-2.03]; P<0.001) were all independently associated with mortality in the overall population. The association between biomarkers and mortality varied across the spectrum of genotypes and left ventricular ejection fraction, with anemia remining independently associated with mortality in p.(V142I) hereditary ATTR-CA (HR, 1.58 [95% CI, 1.17-2.12]; P=0.003) and in a subgroup of the overall population with a left ventricular ejection fraction ≤40% (HR, 1.39 [95% CI, 1.08-1.81]; P=0.01). CONCLUSIONS: Cardiac and noncardiac biomarker abnormalities were common and reflect the complex and multifaceted nature of ATTR-CA, with a wide range of biomarkers remaining independently associated with mortality. Clinical trials are needed to investigate whether biomarker abnormalities represent modifiable risk factors that if specifically targeted could improve outcomes.

Type: Article
Title: Multiorgan Dysfunction and Associated Prognosis in Transthyretin Cardiac Amyloidosis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1161/JAHA.123.033094
Publisher version: http://dx.doi.org/10.1161/jaha.123.033094
Language: English
Additional information: © 2024 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. 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. JAHA is available at: www.ahajournals.org/journal/jaha
Keywords: blood biomarkers, heart failure, mortality, transthyretin cardiac amyloidosis
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 > Eastman Dental Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
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/10186855
Downloads since deposit
10Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item