Incremental prognostic utility of congestion markers in cardiac transthyretin amyloidosis
(2024) In Clinical Research in Cardiology- Abstract
Background/aims: Congestion is prognostically relevant in cardiac transthyretin amyloidosis (ATTR-CA), but whether congestion has an incremental prognostic value beyond the well-established, congestion-sensitive NT-proBNP is unknown. Therefore, we aimed to comparatively evaluate the prognostic utility of several congestion surrogates over NT-proBNP. Methods: We estimated hazard ratios by Cox proportional hazards regressions with time-varying covariates from a panel data set of the local amyloidosis cohort study AmyKoS. Different models were compared by using chi(χ)2-statistics measuring overall model significance. Results/conclusion: 131 ATTR-CA patients (wild-type 84.0%, hereditary 6.9%, without genetic testing 9.2%; median... (More)
Background/aims: Congestion is prognostically relevant in cardiac transthyretin amyloidosis (ATTR-CA), but whether congestion has an incremental prognostic value beyond the well-established, congestion-sensitive NT-proBNP is unknown. Therefore, we aimed to comparatively evaluate the prognostic utility of several congestion surrogates over NT-proBNP. Methods: We estimated hazard ratios by Cox proportional hazards regressions with time-varying covariates from a panel data set of the local amyloidosis cohort study AmyKoS. Different models were compared by using chi(χ)2-statistics measuring overall model significance. Results/conclusion: 131 ATTR-CA patients (wild-type 84.0%, hereditary 6.9%, without genetic testing 9.2%; median age 78.7 (quartiles 73.3, 82.1) years; 85.5% male) with 566 observations across a median follow-up of 38.2 (30.6; 48.2) months were analyzed. 83.2% received disease-modifying treatment; 20.6% participated concurrently in placebo-controlled gene silencer trials. Information on congestion improved biomarker-driven risk stratification and identified patients at the highest risk. Echocardiographic congestion markers performed better than clinical findings and daily diuretic use/dosage. Relevant adjusters were daily diuretic dosage, disease-modifying treatment, eGFR, and right atrial volume. NT-proBNP and the tricuspid regurgitation peak velocity (tr-vmax) provided an easy-to-use stratification with overall model performance similar to NAC and Mayo staging systems. Further analyses are necessary for validation and to identify the optimal cut points of the congestion markers. Graphical abstract: (Figure presented.)
(Less)
- author
- organization
- publishing date
- 2024-08-06
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- ATTR amyloidosis, Cardiac amyloidosis, Congestion, Diuretics, NT-proBNP, Risk stratification, Tricuspid regurgitation peak velocity (tr-v)
- in
- Clinical Research in Cardiology
- article number
- s00392-024-02512-4
- pages
- 11 pages
- publisher
- Steinkopff
- external identifiers
-
- scopus:85200548103
- pmid:39105788
- ISSN
- 1861-0684
- DOI
- 10.1007/s00392-024-02512-4
- language
- English
- LU publication?
- yes
- id
- 68a703a5-eea1-428f-a9b1-c4056f642f31
- date added to LUP
- 2024-08-26 07:31:45
- date last changed
- 2024-09-23 11:22:28
@article{68a703a5-eea1-428f-a9b1-c4056f642f31,
abstract = {{<p>Background/aims: Congestion is prognostically relevant in cardiac transthyretin amyloidosis (ATTR-CA), but whether congestion has an incremental prognostic value beyond the well-established, congestion-sensitive NT-proBNP is unknown. Therefore, we aimed to comparatively evaluate the prognostic utility of several congestion surrogates over NT-proBNP. Methods: We estimated hazard ratios by Cox proportional hazards regressions with time-varying covariates from a panel data set of the local amyloidosis cohort study AmyKoS. Different models were compared by using chi(χ)<sup>2</sup>-statistics measuring overall model significance. Results/conclusion: 131 ATTR-CA patients (wild-type 84.0%, hereditary 6.9%, without genetic testing 9.2%; median age 78.7 (quartiles 73.3, 82.1) years; 85.5% male) with 566 observations across a median follow-up of 38.2 (30.6; 48.2) months were analyzed. 83.2% received disease-modifying treatment; 20.6% participated concurrently in placebo-controlled gene silencer trials. Information on congestion improved biomarker-driven risk stratification and identified patients at the highest risk. Echocardiographic congestion markers performed better than clinical findings and daily diuretic use/dosage. Relevant adjusters were daily diuretic dosage, disease-modifying treatment, eGFR, and right atrial volume. NT-proBNP and the tricuspid regurgitation peak velocity (tr-v<sub>max</sub>) provided an easy-to-use stratification with overall model performance similar to NAC and Mayo staging systems. Further analyses are necessary for validation and to identify the optimal cut points of the congestion markers. Graphical abstract: (Figure presented.)</p>}},
author = {{Ihne-Schubert, Sandra Michaela and Morbach, Caroline and Cejka, Vladimir and Steinhardt, Maximilian Johannes and Papagianni, Aikaterini and Frantz, Stefan and Einsele, Hermann and Wehler, Thomas and Kortüm, Klaus Martin and Sommer, Claudia and Störk, Stefan and Schubert, Torben and Geier, Andreas}},
issn = {{1861-0684}},
keywords = {{ATTR amyloidosis; Cardiac amyloidosis; Congestion; Diuretics; NT-proBNP; Risk stratification; Tricuspid regurgitation peak velocity (tr-v)}},
language = {{eng}},
month = {{08}},
publisher = {{Steinkopff}},
series = {{Clinical Research in Cardiology}},
title = {{Incremental prognostic utility of congestion markers in cardiac transthyretin amyloidosis}},
url = {{http://dx.doi.org/10.1007/s00392-024-02512-4}},
doi = {{10.1007/s00392-024-02512-4}},
year = {{2024}},
}