Banydeen Rishika, Signate Aissatou, Tran Tuan-Huy, Monfort Astrid, Neviere Remi, Inamo Jocelyn
Clinical Research Department, CHU Martinique (University Hospital of Martinique), Fort de France, France.
Cardiovascular Research Team EA7525, Université des Antilles (University of the French West Indies), Fort de France, France.
Front Neurol. 2022 May 19;13:878292. doi: 10.3389/fneur.2022.878292. eCollection 2022.
The link between transthyretin cardiac amyloidosis (CATTR), and cerebral ischemic events (CIE) has only been hinted at till now, impeding progress in patient management. We seek to evaluate the frequency and characteristics of CIE in Afro-Caribbean patients followed for CATTR at our institution.
In this single-center retrospective observational study, Afro-Caribbean patients followed for CATTR between July 2005 and October 2019 were included. Occurrence of CIE was investigated, and their cardioembolic origin determined. Analysis of patient characteristics was conducted according to CIE and CATTR profiles.
Overall, 120 CATTR patients were included: 17 wild-type ATTR (14.2%), 73 ATTR-V122I (60.8%), and 22 ATTR-I107V (18.3%). Thirty-six patients (30.0%) presented with CIE, including three transient ischemic attacks and 33 permanent ischemic strokes (75.8% with a cardioembolic pattern). CIE was concomitant with CATTR diagnosis in 16 (16/36: 44.4%) patients, while 14 patients (14/36: 38.9 %) experienced CIE over a median CATTR follow-up of 2.0 years (min-max range: 0.8-4.4 years). CATTR-CIE patients presented with atrial fibrillation (66.7%), left atrial enlargement (77.8%), a CHADS-VASc ≥ 3 (97.2%) and a high anticoagulant intake (75.0%). Multivariate analysis retained only a high CHADS-VASc score as an independent predictor of CIE risk (Hazard Ratio [95% CI]: 12.03 [1.62-89.24]).
Concomitant CIE, and CATTR diagnosis, potentially carries a worse prognosis. A CHADS-VASc score ≥3 seems to be a strong and independent predictive factor of CIE in CATTR patients. Further studies are needed to assess the efficacy and timeliness of anticoagulation in CATTR patients, independently of atrial fibrillation.
甲状腺素运载蛋白心脏淀粉样变性（CATTR）与脑缺血事件（CIE）之间的联系迄今仅被提及，这阻碍了患者管理方面的进展。我们试图评估在我们机构接受CATTR治疗的非洲加勒比裔患者中CIE的发生频率和特征。
在这项单中心回顾性观察研究中，纳入了2005年7月至2019年10月期间接受CATTR治疗的非洲加勒比裔患者。调查CIE的发生情况，并确定其心源性栓塞起源。根据CIE和CATTR特征对患者特征进行分析。
总体而言，共纳入120例CATTR患者：17例野生型ATTR（14.2%），73例ATTR-V122I（60.8%），22例ATTR-I107V（18.3%）。36例患者（30.0%）出现CIE，包括3例短暂性脑缺血发作和33例永久性缺血性卒中（75.8%为心源性栓塞型）。16例（16/36：44.4%）患者的CIE与CATTR诊断同时出现，而14例患者（14/36：38.9%）在CATTR中位随访2.0年（最小-最大范围：0.8-4.4年）期间发生CIE。CATTR-CIE患者表现为心房颤动（66.7%）、左心房扩大（77.8%）、CHADS-VASc≥3（97.2%）和高抗凝剂摄入量（75.0%）。多变量分析仅保留高CHADS-VASc评分作为CIE风险的独立预测因素（风险比[95%置信区间]：12.03[1.62-89.24]）。
CIE与CATTR诊断同时存在可能预后更差。CHADS-VASc评分≥3似乎是CATTR患者CIE的一个强有力的独立预测因素。需要进一步研究评估CATTR患者抗凝治疗的有效性和及时性，而不考虑心房颤动。
