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Cardio-Hepatic Interaction in Cardiac Amyloidosis

Ihne-Schubert, Sandra Michaela LU ; Goetze, Oliver ; Gerstendörfer, Felix ; Sahiti, Floran ; Schade, Ina ; Papagianni, Aikaterini ; Morbach, Caroline ; Frantz, Stefan ; Einsele, Hermann and Knop, Stefan , et al. (2024) In Journal of Clinical Medicine 13(5).
Abstract

Background: Congestion is associated with poor prognosis in cardiac amyloidosis (CA). The cardio-hepatic interaction and the prognostic impact of secondary liver affection by cardiac congestion in CA are poorly understood and require further characterisation. Methods: Participants of the amyloidosis cohort study AmyKoS at the Interdisciplinary Amyloidosis Centre of Northern Bavaria with proven transthyretin (ATTR-CA) and light chain CA (AL-CA) underwent serial work-up including laboratory tests, echocardiography, and in-depth hepatic assessment by vibration-controlled transient elastography (VCTE) and 13C-methacetin breath test. Results: In total, 74 patients with AL-CA (n = 17), ATTR-CA (n = 26) and the controls (n = 31)... (More)

Background: Congestion is associated with poor prognosis in cardiac amyloidosis (CA). The cardio-hepatic interaction and the prognostic impact of secondary liver affection by cardiac congestion in CA are poorly understood and require further characterisation. Methods: Participants of the amyloidosis cohort study AmyKoS at the Interdisciplinary Amyloidosis Centre of Northern Bavaria with proven transthyretin (ATTR-CA) and light chain CA (AL-CA) underwent serial work-up including laboratory tests, echocardiography, and in-depth hepatic assessment by vibration-controlled transient elastography (VCTE) and 13C-methacetin breath test. Results: In total, 74 patients with AL-CA (n = 17), ATTR-CA (n = 26) and the controls (n = 31) were analysed. ATTR-CA patients showed decreased microsomal liver function expressed by maximal percentage of dose rate (PDRpeak) related to hepatic congestion. Reduced PDRpeak in AL-CA could result from altered pharmacokinetics due to changed hepatic blood flow. Liver stiffness as a combined surrogate of chronic liver damage and congestion was identified as a predictor of all-cause mortality. Statistical modelling of the cardio-hepatic interaction revealed septum thickness, NT-proBNP and PDRpeak as predictors of liver stiffness in both CA subtypes; dilatation of liver veins and the fibrosis score FIB-4 were only significant for ATTR-CA. Conclusions: Non-invasive methods allow us to characterise CA-associated hepatic pathophysiology. Liver stiffness might be promising for risk stratification in CA.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
C-methacetin breath test (MBT), cardiac amyloidosis, congestion, liver stiffness, PDR, vibration-controlled transient elastography (VTCE)
in
Journal of Clinical Medicine
volume
13
issue
5
article number
1440
publisher
MDPI AG
external identifiers
  • scopus:85187424457
ISSN
2077-0383
DOI
10.3390/jcm13051440
language
English
LU publication?
yes
id
39f571ab-4bd3-430c-aa45-99e30442f9f7
date added to LUP
2024-04-08 10:32:38
date last changed
2024-04-08 10:33:05
@article{39f571ab-4bd3-430c-aa45-99e30442f9f7,
  abstract     = {{<p>Background: Congestion is associated with poor prognosis in cardiac amyloidosis (CA). The cardio-hepatic interaction and the prognostic impact of secondary liver affection by cardiac congestion in CA are poorly understood and require further characterisation. Methods: Participants of the amyloidosis cohort study AmyKoS at the Interdisciplinary Amyloidosis Centre of Northern Bavaria with proven transthyretin (ATTR-CA) and light chain CA (AL-CA) underwent serial work-up including laboratory tests, echocardiography, and in-depth hepatic assessment by vibration-controlled transient elastography (VCTE) and <sup>13</sup>C-methacetin breath test. Results: In total, 74 patients with AL-CA (n = 17), ATTR-CA (n = 26) and the controls (n = 31) were analysed. ATTR-CA patients showed decreased microsomal liver function expressed by maximal percentage of dose rate (PDR<sub>peak</sub>) related to hepatic congestion. Reduced PDR<sub>peak</sub> in AL-CA could result from altered pharmacokinetics due to changed hepatic blood flow. Liver stiffness as a combined surrogate of chronic liver damage and congestion was identified as a predictor of all-cause mortality. Statistical modelling of the cardio-hepatic interaction revealed septum thickness, NT-proBNP and PDR<sub>peak</sub> as predictors of liver stiffness in both CA subtypes; dilatation of liver veins and the fibrosis score FIB-4 were only significant for ATTR-CA. Conclusions: Non-invasive methods allow us to characterise CA-associated hepatic pathophysiology. Liver stiffness might be promising for risk stratification in CA.</p>}},
  author       = {{Ihne-Schubert, Sandra Michaela and Goetze, Oliver and Gerstendörfer, Felix and Sahiti, Floran and Schade, Ina and Papagianni, Aikaterini and Morbach, Caroline and Frantz, Stefan and Einsele, Hermann and Knop, Stefan and Sommer, Claudia and Müllhaupt, Beat and Schubert, Torben and Störk, Stefan and Geier, Andreas}},
  issn         = {{2077-0383}},
  keywords     = {{C-methacetin breath test (MBT); cardiac amyloidosis; congestion; liver stiffness; PDR; vibration-controlled transient elastography (VTCE)}},
  language     = {{eng}},
  number       = {{5}},
  publisher    = {{MDPI AG}},
  series       = {{Journal of Clinical Medicine}},
  title        = {{Cardio-Hepatic Interaction in Cardiac Amyloidosis}},
  url          = {{http://dx.doi.org/10.3390/jcm13051440}},
  doi          = {{10.3390/jcm13051440}},
  volume       = {{13}},
  year         = {{2024}},
}