Right Ventricular Function and Prognosis in Patients with Transthyretin Amyloid Cardiomyopathy

pp. 182-187

Abstract

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an infiltrative disease that impairs the diastolic and systolic function of the heart, affecting both left and right chambers. This study evaluated the frequency of right ventricle (RV) function involvement and its prognostic impact.

Methods: This was a retrospective analysis of a cohort of 154 patients with ATTR-CM in a specialized cardiology center. Clinical, laboratory and echocardiographic data, risk factors and cardiovascular events were collected. The relationship of RV function with prognosis was assessed using the Cox proportional hazards model.

Results: Median age was 81 years (interquartile range, IQR, 75-85), and 95% of patients were men. Forty-seven percent of cases had tricuspid annular plane systolic excursion (TAPSE) <17 mm and 52% had RV S-wave <9.5 cm/s. Mean pulmonary pressure was 40 mmHg (IQR 33-50), and 21.7% showed moderate-severe tricuspid regurgitation. During a median follow-up of 528 days (IQR 159-1004), total mortality was 19.3%, cardiovascular mortality 11.8%, hospitalization for heart failure (HHF) 30.5%, and incidence of atrial fibrillation (AF) 30.4%. TAPSE was an independent predictor of total mortality (HR 0.847, 95% CI 0.730-0.983, p=0.028), cardiovascular mortality (HR 0.725, 95% CI 0.600-0.875, p=0.001), HHF (HR 0.859, 95% CI 0.755-0.977, p=0.001), and AF (HR 0.841, 95% CI 0.727-0.972, p=0.019).

Conclusion: Right ventricular dysfunction is frequent in ATTR-CM. TAPSE, as a simple parameter, independently predicts mortality, cardiovascular events and AF in the mid-term.

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an infiltrative disease that impairs the diastolic and systolic function of the heart, affecting both left and right chambers. This study evaluated the frequency of right ventricle (RV) function involvement and its prognostic impact.

Methods: This was a retrospective analysis of a cohort of 154 patients with ATTR-CM in a specialized cardiology center. Clinical, laboratory and echocardiographic data, risk factors and cardiovascular events were collected. The relationship of RV function with prognosis was assessed using the Cox proportional hazards model.

Results: Median age was 81 years (interquartile range, IQR, 75-85), and 95% of patients were men. Forty-seven percent of cases had tricuspid annular plane systolic excursion (TAPSE) <17 mm and 52% had RV S-wave <9.5 cm/s. Mean pulmonary pressure was 40 mmHg (IQR 33-50), and 21.7% showed moderate-severe tricuspid regurgitation. During a median follow-up of 528 days (IQR 159-1004), total mortality was 19.3%, cardiovascular mortality 11.8%, hospitalization for heart failure (HHF) 30.5%, and incidence of atrial fibrillation (AF) 30.4%. TAPSE was an independent predictor of total mortality (HR 0.847, 95% CI 0.730-0.983, p=0.028), cardiovascular mortality (HR 0.725, 95% CI 0.600-0.875, p=0.001), HHF (HR 0.859, 95% CI 0.755-0.977, p=0.001), and AF (HR 0.841, 95% CI 0.727-0.972, p=0.019).

Conclusion: Right ventricular dysfunction is frequent in ATTR-CM. TAPSE, as a simple parameter, independently predicts mortality, cardiovascular events and AF in the mid-term.