Hein Selina J, Knoll Maximilian, Aus dem Siepen Fabian, Furkel Jennifer, Schoenland Stefan, Hegenbart Ute, Katus Hugo A, Kristen Arnt V, Konstandin Mathias
Department of Cardiology, Pneumology and Angiology, University Hospital Heidelberg, Heidelberg, BW 69120, Germany.
Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center, German Cancer Research Center, University Hospital Heidelberg, Heidelberg, BW 69120, Germany.
World J Cardiol. 2021 Mar 26;13(3):55-67. doi: 10.4330/wjc.v13.i3.55.
Elevated interleukin (IL)-6-levels have been described in familial variant transthyretin amyloidosis (ATTRv) associated polyneuropathy and heart failure. However, IL-6 in cardiac ATTR amyloidosis (ATTR-CM) and its prognostic value have not been investigated yet.
We aim to study the correlation between IL-6 levels with clinical presentation (Gillmore-class) and outcome [heart transplantation or death (htx/death)], or the combined endpoint of cardiac decompensation or htx/death in ATTR-CM.
IL-6 levels of 106 ATTR-CM patients [54 wild-type ATTRwt, 52 ATTRv-CM], 15 asymptomatic carriers of ATTR mutations (aATTRv-CM) and 27 healthy donors were quantified using Luminex technology. Statistical analysis was performed using parametric survival regression models.
We found that IL-6 levels from wild-type ATTR patients were significantly elevated compared to healthy controls, while aATTRv-CM carriers and ATTRv-CM patients did not show a significant difference. IL-6 levels showed significantly higher values in increasing Gillmore classes. Univariate analyses revealed association of low IL-6 levels with cardiac decompensation and htx/death [odds ratio: 0.26 (0.09-0.72), = 0.01] and htx/death [odds ratio: 0.15 (0.04-0.58), = 0.006]. However, in the multivariate model, no significant improvement of risk prediction was seen for IL-6, while established prognostic factors were significantly associated with outcome.
Raised IL-6 levels correlate with clinical presentation and are associated with worse outcome in ATTR-CM but do not improve stratification in addition to established risk factors.
在家族性变异型转甲状腺素蛋白淀粉样变性（ATTRv）相关的多发性神经病和心力衰竭中，白细胞介素（IL）-6水平升高已有报道。然而，心脏ATTR淀粉样变性（ATTR-CM）中的IL-6及其预后价值尚未得到研究。
我们旨在研究IL-6水平与临床表现（吉尔摩分级）和结局[心脏移植或死亡（htx/死亡）]之间的相关性，或ATTR-CM中心脏失代偿或htx/死亡的联合终点之间的相关性。
使用Luminex技术对106例ATTR-CM患者[54例野生型ATTRwt，52例ATTRv-CM]、15例ATTR突变无症状携带者（aATTRv-CM）和27例健康供体的IL-6水平进行定量。使用参数生存回归模型进行统计分析。
我们发现野生型ATTR患者的IL-6水平与健康对照相比显著升高，而aATTRv-CM携带者和ATTRv-CM患者之间没有显著差异。IL-6水平在吉尔摩分级增加时显示出显著更高的值。单因素分析显示低IL-6水平与心脏失代偿和htx/死亡相关[比值比：0.26（0.09-0.72），P = 0.01]以及与htx/死亡相关[比值比：0.15（0.04-0.58），P = 0.006]。然而，在多变量模型中，IL-6在风险预测方面没有显著改善，而既定的预后因素与结局显著相关。
升高的IL-6水平与临床表现相关，并且在ATTR-CM中与更差的结局相关，但除既定的危险因素外，并未改善分层。
