Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis · 2024
Incidence and predictors of sudden death in patients with cardiac amyloidosis.
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de Frutos Fernando, Saturi Giulia, Gonzalez-Lopez Esther, Sguazzotti Maurizio, Dominguez Fernando, Ponziani Alberto, Cabrera-Romero Eva, Caponetti Angelo Giuseppe, Lozano Sara, Massa Paolo, Peiro-Aventin Belen, Accietto Antonella, Mora-Ayestarán Nerea, Giovannetti Alessandro, Castro-Urda Victor, Gagliardi Christian, Cobo-Marcos Marta, Rios-Tamayo Rafael, Biagini Elena, Gomez-Bueno Manuel, Galiè Nazzareno, Segovia-Cubero Javier, Longhi Simone, Garcia-Pavia Pablo
Аннотация
INTRODUCTION: Although sudden death (SD) is a recognized complication of cardiac amyloidosis, there is scarce data about its incidence, mechanisms, and predictors. The aim of this study was to describe incidence of SD and to analyze possible risk factors.
METHODS: Consecutive patients with ATTR or AL cardiac amyloidosis evaluated at two European centers were identified. SD was defined as unexpected death in clinically stable patients. Cox proportional hazard regression was performed to assess risk factors in univariate analysis. Those statistically significant were then assessed through age-adjusted multivariate analysis.
RESULTS: Analysis included 784 patients, 569 with ATTR amyloidosis (mean age 74.1 ± 12.1 years) and 215 with AL amyloidosis (mean age 64.5 ± 10.8 years). After a median follow-up of 1.9 years, SD rate at 2 years was 1.8% in ATTR. Previous pacemaker implantation (PPM) was associated with increased risk after age-adjusted analysis (HR 4.97; 95%CI: 1.39-17.7; p = 0.01). SD rate in AL amyloidosis patients at 2 years was 8.0% after a median follow-up of 1.2 years. Betablockers and NYHA III-IV were independently associated with an increased risk after age-adjusted multivariate analysis (HR 7.06 95%CI (2.31-21.5) p = 0.001) and (HR 4.56 95%CI (1.51-13.8) p = 0.007) respectively.
CONCLUSIONS: SD is more frequent in AL than in ATTR cardiac amyloidosis. SD is associated with different risk factors in both entities.
METHODS: Consecutive patients with ATTR or AL cardiac amyloidosis evaluated at two European centers were identified. SD was defined as unexpected death in clinically stable patients. Cox proportional hazard regression was performed to assess risk factors in univariate analysis. Those statistically significant were then assessed through age-adjusted multivariate analysis.
RESULTS: Analysis included 784 patients, 569 with ATTR amyloidosis (mean age 74.1 ± 12.1 years) and 215 with AL amyloidosis (mean age 64.5 ± 10.8 years). After a median follow-up of 1.9 years, SD rate at 2 years was 1.8% in ATTR. Previous pacemaker implantation (PPM) was associated with increased risk after age-adjusted analysis (HR 4.97; 95%CI: 1.39-17.7; p = 0.01). SD rate in AL amyloidosis patients at 2 years was 8.0% after a median follow-up of 1.2 years. Betablockers and NYHA III-IV were independently associated with an increased risk after age-adjusted multivariate analysis (HR 7.06 95%CI (2.31-21.5) p = 0.001) and (HR 4.56 95%CI (1.51-13.8) p = 0.007) respectively.
CONCLUSIONS: SD is more frequent in AL than in ATTR cardiac amyloidosis. SD is associated with different risk factors in both entities.