May 18, 2012Journal of Cardiovascular Medicine18 citations
Focus on cardiac amyloidosis
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Key Result
The presence of heart failure at enrollment (HR 4.67; 95% CI 1.07-20.27; P=0.04) and a history of recent syncope (HR 3.97; 95% CI 1.28-12.34; P=0.017) independently predicted cardiac death.
Study Design
Type
Cohort (n=48)
Structured PICO
P
Population
48 patients (mean age 63 years, 35% female) with biopsy-proven amyloidosis and heart involvement, followed for a median of 9.5 months.
O
Outcome
cardiac mortalityhard clinical
In patients with cardiac amyloidosis, the presence of heart failure and a history of recent syncope are strong independent predictors of short-term cardiac mortality.
Main Result
Hazard Ratio: 4.67 (95% CI 1.07–20.27)
p-value: p=0.04
Abstract
AIM: Amyloidosis is a systemic disease, related to different underlying causes, with frequent cardiac involvement. Clinical evaluation, echocardiography and electrocardiography represent important noninvasive tools in identification of cardiac involvement. The aim of this study was to assess the clinical-laboratory features of a series of patients affected by cardiac amyloidosis in order to evaluate the risk of cardiac mortality. METHODS: We evaluated 48 patients (men 65%, mean age 63 ± 11 years) with biopsy-proven diagnosis of amyloidosis and heart involvement observed from 1991 to 2009. All patients underwent clinical-laboratory evaluation at baseline and were followed up. RESULTS: During a median follow-up of 9.5 months (first to third interquartile: 3-41.5 months), 24 patients (50%) died as a result of a cardiac cause. Survival free from cardiac death was 69, 50, 48 and 41% at 6, 12, 24 and 60 months from diagnosis, respectively. At multivariable Cox regression analysis, the presence of heart failure at enrolment hazard ratio (HR) 4.67, 95% confidence interval (CI) 1.07-20.27, P = 0.04 and history of recent syncope (HR 3.97, 95% CI 1.28-12.34, P = 0.017) emerged as independent predictors of cardiac death. By using the equation derived from the multivariate analysis, individual survival probability at different times of follow-up was calculated. CONCLUSION: We confirm the particularly poor outcome of cardiac amyloidosis in the short term. A careful clinical evaluation emerges as the most important tool for the prognostic stratification and quantification of risk in patients with cardiac amyloidosis.