Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis · 2025
Cold pressor test and paradoxical blood pressure reduction in light chain amyloidosis.
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Patras Raphael, Georgiopoulos Georgios, Theodorakakou Foteini, Petropoulos Ioannis, Delialis Dimitris, Angelidakis Lasthenis, Briasoulis Alexandros, Gavriatopoulou Maria, Kokotis Panagiotis, Manios Efstathios, Dimopoulos Meletios-Athanasios, Kastritis Efstathios, Stamatelopoulos Kimon
Аннотация
BACKGROUND: Patients with AL amyloidosis present sustained paradoxical vasodilation in response to sympathetic stimulation by cold pressor test (CPT). The clinical relevance is unknown.
METHODS: Peripheral and central systolic (SBP) and diastolic blood pressure (DBP) were measured at 3 min (end of CPT) and at 6 min, before and 12 months after treatment initiation in 113 treatment-naïve AL amyloidosis patients. Ten healthy volunteers were assessed at baseline. All-cause and cardiovascular mortality were recorded.
RESULTS: Percentage reductions in central SBP and peripheral DBP at 6 min [AL vs controls: %CSBP6min (mean, SD) 0.7 ± 8.44 vs 7.57 ± 5.59; %DBP6min (mean, SD) 0.64 ± 8.91 vs 14 ± 9.11; p < 0.01 for both] were associated with all-cause and cardiovascular death (%CSBP6min HR = 0.945 and HR = 0.946 respectively; %DBP6min HR = 0.949 and HR = 0.916 respectively; p < 0.05 for all) after adjustment for disease-related risk factors. %CSBP6min provided incremental value over Mayo stage and was associated with neurological and cardiac dysfunction and myocardial infiltration. At 12 months, %CSBP6min further decreased in patients with earlier poor hematologic treatment response.
CONCLUSIONS: %CSBP6min, a noninvasive, readily available marker, was associated with cardiac dysfunction, poor survival, and its further post-treatment reduction was associated with hematologic response.
METHODS: Peripheral and central systolic (SBP) and diastolic blood pressure (DBP) were measured at 3 min (end of CPT) and at 6 min, before and 12 months after treatment initiation in 113 treatment-naïve AL amyloidosis patients. Ten healthy volunteers were assessed at baseline. All-cause and cardiovascular mortality were recorded.
RESULTS: Percentage reductions in central SBP and peripheral DBP at 6 min [AL vs controls: %CSBP6min (mean, SD) 0.7 ± 8.44 vs 7.57 ± 5.59; %DBP6min (mean, SD) 0.64 ± 8.91 vs 14 ± 9.11; p < 0.01 for both] were associated with all-cause and cardiovascular death (%CSBP6min HR = 0.945 and HR = 0.946 respectively; %DBP6min HR = 0.949 and HR = 0.916 respectively; p < 0.05 for all) after adjustment for disease-related risk factors. %CSBP6min provided incremental value over Mayo stage and was associated with neurological and cardiac dysfunction and myocardial infiltration. At 12 months, %CSBP6min further decreased in patients with earlier poor hematologic treatment response.
CONCLUSIONS: %CSBP6min, a noninvasive, readily available marker, was associated with cardiac dysfunction, poor survival, and its further post-treatment reduction was associated with hematologic response.