Decotto Santiago, Iroulart Juan María, Roveda Guido, Villanueva Eugenia, Aguirre María Adela, Posadas-Martinez María Lourdes, Nucifora Elsa, Pizarro Rodolfo, Pérez de Arenaza Diego
Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Cardiology Department Hospital Italiano de Buenos Aires Buenos Aires Argentina.
Internal Medicine Department. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Internal Medicine Department Hospital Italiano de Buenos Aires Buenos Aires Argentina.
Arch Peru Cardiol Cir Cardiovasc. 2024 Jun 24;5(2):e388. doi: 10.47487/apcyccv.v5i2.388. eCollection 2024 Apr-Jun.
Patients diagnosed with transthyretin amyloid cardiomyopathy (ATTR-CM) often experience poor outcomes due to the development of heart failure (HF). Tricuspid regurgitation (TR) has been found to be correlated with adverse outcomes in patients with HF. This study aims to assess whether the presence of significant TR is associated to adverse cardiac outcomes in patients diagnosed with ATTR-CM.
Retrospective study of ATTR-CM patients enrolled in the Institutional Registry of Amyloidosis (NCT01347047). Patients were categorized based on the presence of significant TR (moderate or severe according to current guidelines criteria) or absence of significant TR. All patients were followed up for 2 years to assess the incidence of the composite outcome of death or HF hospitalization.
A total of 93 ATTR-CM patients were included. The mean age at diagnosis was 82.5 [IQR 75 - 86] years, 86% were male, and the mean left ventricular ejection fraction was 52% [IQR 43 - 60]. Among them, 32.3% (n = 30) patients had significant TR. Patients with significant TR had higher NTpro-BNP values (5308 vs 2454, pg/mL, p = 0.004), and a lower left ventricular ejection fraction (44 vs. 56%, p = 0.0002) compared to patients without significant TR. The incidence of the primary outcome was higher in patients with significant TR (77% vs. 30%, p<0.001). In a multivariate Cox regression analysis, only NTpro-BNP, as a numerical variable (HR 1.00, 95% CI 1.00005-1.0002, p = 0.001), and significant TR (HR 2.23, 95% CI 1.12-4.42, p=0.021) were independently associated with the composite outcome of death or HF hospitalization.
In patients diagnosed with ATTR-CM, the presence of significant TR was associated with worse outcomes.
被诊断为转甲状腺素蛋白淀粉样心肌病（ATTR-CM）的患者常因心力衰竭（HF）的发展而预后不良。已发现三尖瓣反流（TR）与HF患者的不良预后相关。本研究旨在评估显著TR的存在是否与被诊断为ATTR-CM的患者的不良心脏结局相关。
对纳入淀粉样变性疾病机构登记处（NCT01347047）的ATTR-CM患者进行回顾性研究。根据是否存在显著TR（根据当前指南标准为中度或重度）对患者进行分类。对所有患者进行2年随访，以评估死亡或HF住院复合结局的发生率。
共纳入93例ATTR-CM患者。诊断时的平均年龄为82.5岁[四分位间距75 - 86岁]，86%为男性，平均左心室射血分数为52%[四分位间距43 - 60%]。其中，32.3%（n = 30）的患者有显著TR。与无显著TR的患者相比，有显著TR的患者NTpro-BNP值更高（5308对2454，pg/mL，p = 0.004），左心室射血分数更低（44%对56%，p = 0.0002）。有显著TR的患者主要结局的发生率更高（77%对30%，p<0.001）。在多变量Cox回归分析中，只有NTpro-BNP作为数值变量（风险比1.00，95%置信区间1.00005 - 1.0002，p = 0.001）和显著TR（风险比2.23，95%置信区间1.12 - 4.42，p = 0.021）与死亡或HF住院的复合结局独立相关。
在被诊断为ATTR-CM的患者中，显著TR的存在与更差的结局相关。
