Clinical InvestigationIndependent Predictors of Survival in Primary Systemic (AL) Amyloidosis, Including Cardiac Biomarkers and Left Ventricular Strain Imaging: An Observational Cohort Study
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Study Population
This study was approved by the institutional review board of the Mayo Clinic. Subjects with AL amyloidosis were prospectively selected from patients undergoing evaluation in the Division of Hematology at the Mayo Clinic (Rochester, MN) from January 1, 2004, through October 31, 2005, and referred for echocardiography. A cohort of 279 consecutive patients with AL amyloidosis who underwent complete echocardiographic and Doppler exams constituted the initial study population. All patients were
Results
Baseline demographic and clinical variables as well as cardiac and hematologic biomarker levels are detailed in Table 1. Standard 2-dimensional and Doppler echocardiographic results are detailed in Table 2. Longitudinal systolic and diastolic DMI measurements for our study population are displayed in Table 3, Table 4, respectively.
The mean age was 63 years, and 155 patients (68%) were men. The heart was the major organ involved in 93 patients (37%), and myocardial biopsy was performed in 37
Discussion
The main findings of the current investigation are as follows: (1) in patients with AL amyloid, clinical variables, biomarkers, and DMI echocardiography were predictive of mortality; (2) ejection time was confirmed as an essential independent predictor of survival; and (3) longitudinal systolic DMI measurements, specifically sSR and sS, were among the most significant independent predictors of survival in multivariate analysis.
Different studies have demonstrated the prognostic usefulness of
Conclusion
We compared for the first time clinical, laboratory, and extensive echocardiographic variables to define the most significant independent predictors of survival for patients with AL amyloid, and the cut points for NYHA class III or IV, presence of pleural effusion, BNP level > 493 pg/mL, and LV ejection time < 273 ms identified patients with the worst prognoses. Similarly, longitudinal sS in the basal anteroseptal segment less negative than −7.5% was a powerful predictor of poor clinical
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2021, Mayo Clinic ProceedingsCitation Excerpt :A conversion table for all cardiac biomarkers by the various cardiac models can be viewed in Table 3. Echocardiographic parameters, such as ejection fraction, longitudinal left ventricular strain,61 and stroke volume index,62 are prognostic as well. However, they may be limited by variability in local expertise and imaging protocols.
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2020, Journal of the American Society of EchocardiographyCitation Excerpt :The main findings were as follows: (1) patients with CA display substantially decreased LVMWI and poorer LVMWE at rest compared with control subjects; (2) the differences are more pronounced in the basal myocardial segments compared with the apical myocardial segments; (3) LVMWI reserve is severely reduced in patients with CA compared with control subjects; and (4) LVMWI, as a supplement to LVGLS, identifies patients with poor exercise capacity and increased levels of surrogate prognostic makers. LVGLS has proven benefit for the determination of functional CA burden and possesses prognostic value in patients with CA.7-15 Furthermore, relative apical sparing of longitudinal strain is a typical finding in patients with CA that enables discrimination from other etiologies for LV hypertrophy.14