Portal de Periódicos da CAPES

Right ventricular to pulmonary artery coupling and outcome in patients with cardiac amyloidosis

2023; Oxford University Press; Volume: 24; Issue: 10 Linguagem: Inglês

10.1093/ehjci/jead145

2047-2412

Daniela Tomasoni, Marianna Adamo, Aldostefano Porcari, Alberto Aimo, Giovanni Battista Bonfioli, Vincenzo Castiglione, Maria Franzini, Riccardo M. Inciardi, Anas Khalil, Carlo Lombardi, Laura Lupi, Matilde Nardi, Chiara Oriecuia, Matteo Pagnesi, Giorgia Panichella, Maddalena Rossi, Nicola Saccani, Claudia Specchia, Giuseppe Vergaro, Marco Merlo, Gianfranco Sinagra, Michele Emdin, Marco Metra,

Cardiovascular Function and Risk Factors

To investigate the prognostic value of the right ventricle-to-pulmonary artery (RV-PA) coupling in patients with either transthyretin (ATTR) or immunoglobulin light-chain (AL) cardiac amyloidosis (CA).Overall, 283 patients with CA from 3 Italian high-volume centres were included (median age 76 years; 63% males; 53% with ATTR-CA, 47% with AL-CA). The RV-PA coupling was evaluated by using the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio. The median value of TAPSE/PASP was 0.45 (0.33-0.63) mm/mmHg. Patients with a TAPSE/PASP ratio <0.45 were older, had lower systolic blood pressure, more severe symptoms, higher cardiac troponin and N-terminal pro-B-type natriuretic peptide levels, greater left ventricular (LV) thickness, and worse LV systolic and diastolic function. A TAPSE/PASP ratio <0.45 was independently associated with a higher risk of all-cause death or heart failure (HF) hospitalization [hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.32-2.96; P = 0.001] and all-cause death (HR 2.18, 95% CI 1.31-3.62; P = 0.003). The TAPSE/PASP ratio reclassified the risk of both endpoints [net reclassification index 0.46 (95% CI 0.18-0.74) P = 0.001 and 0.49 (0.22-0.77) P < 0.001, respectively], while TAPSE or PASP alone did not (all P > 0.05). The prognostic impact of the TAPSE/PASP ratio was significant both in AL-CA patients (HR for the composite endpoint 2.47, 95% CI 1.58-3.85; P < 0.001) and in ATTR-CA (HR 1.81, 95% CI 1.11-2.95; P = 0.017). The receiver operating characteristic curve showed that the optimal cut-off for predicting prognosis was 0.47 mm/mmHg.In patients with CA, RV-PA coupling predicted the risk of mortality or HF hospitalization. The TAPSE/PASP ratio was more effective than TAPSE or PASP in predicting prognosis.