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Erschienen in:

18.11.2022 | EM - ORIGINAL

Prognostic value of cardiopulmonary exercise testing in patients with transthyretin cardiac amyloidosis

verfasst von: Maria Vittoria Silverii, Alessia Argirò, Samuele Baldasseroni, Carlo Fumagalli, Mattia Zampieri, Ludovica Guerrieri, Simone Bartolini, Carlotta Mazzoni, Costanza Burgisser, Alessia Tomberli, Carlo Di Mario, Niccolò Marchionni, Iacopo Olivotto, Federico Perfetto, Francesco Fattirolli, Francesco Cappelli

Erschienen in: Internal and Emergency Medicine | Ausgabe 2/2023

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Abstract

The aim of this study is to evaluate the prognostic value of cardiopulmonary testing (CPET) in a cohort of patients with transthyretin cardiac amyloidosis (ATTR-CA). ATTR-CA is associated with a progressive reduction in functional capacity. The prognostic role of CPET parameters and in particular of normalized peak VO2 (%ppVO2) remains to be thoroughly evaluated. In this study, 75 patients with ATTR-CA underwent cardiological evaluation and CPET in a National Referral Center for cardiac amyloidosis (Careggi University Hospital, Florence). Fifty-seven patients (76%) had wild-type ATTR. Median age was 80 (75–83) years, 68 patients (91%) were men. Peak oxygen consumption (14.1 ± 4.1 ml/kg/min) and %ppVO₂ (68.4 ± 18.8%) were blunted. Twenty-seven (36%) patients had an abnormal pressure response to exercise. After a median follow-up of 25 (12–31) months, the composite outcome of death or heart failure hospitalization was registered in 19 (25.3%) patients. At univariate analysis %ppVO₂ was a stronger predictor for the composite outcome than peak VO₂. %ppVO₂ and NT-proBNP remained associated with the composite outcome at multivariate analysis. The optimal predictive threshold for %ppVO₂ was 62% (sensitivity: 71%; specificity: 68%; AUC: 0.77, CI 0.65–0.88). Patients with %ppVO₂ ≤ 62%and NT-proBNP > 3000 pg had a worse prognosis with 1- and 2-year survival of 69 ± 9% and 50 ± 10%, respectively. CPET is a safe and useful prognostic tool in patients with ATTR-CA. CPET may help to identify patients with advanced disease that may benefit from targeted therapy.

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Titel: Prognostic value of cardiopulmonary exercise testing in patients with transthyretin cardiac amyloidosis
verfasst von: Maria Vittoria Silverii
Alessia Argirò
Samuele Baldasseroni
Carlo Fumagalli
Mattia Zampieri
Ludovica Guerrieri
Simone Bartolini
Carlotta Mazzoni
Costanza Burgisser
Alessia Tomberli
Carlo Di Mario
Niccolò Marchionni
Iacopo Olivotto
Federico Perfetto
Francesco Fattirolli
Francesco Cappelli
Publikationsdatum: 18.11.2022
Verlag: Springer International Publishing
Erschienen in: Internal and Emergency Medicine / Ausgabe 2/2023
Print ISSN: 1828-0447
Elektronische ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-022-03125-3

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Prognostic value of cardiopulmonary exercise testing in patients with transthyretin cardiac amyloidosis

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