Right ventricular dysfunction assessed by low TAPSE (< 14 mm) independently predicted major adverse cardiac events in patients with cardiac amyloidosis.
Cohort (n=129)
Does right ventricular systolic function assessment predict major adverse cardiac events in patients with cardiac amyloidosis?
Routine evaluation of right ventricular systolic function using TAPSE provides independent prognostic value for major adverse cardiac events in patients with cardiac amyloidosis.
BACKGROUND: Right ventricular (RV) dysfunction is a strong predictor of poor outcomes in heart failure. Its prognostic meaning in cardiac amyloidosis (CA) is under-investigated. METHODS: Hundred and twenty nine patients with suspected CA and an interventricular septum thickness (IVST) ≥ 12 mm underwent echocardiography with measurement of left ventricular (LV) and RV longitudinal strain (LS), late gadolinium-enhancement (LGE) cardiac MRI, and standard evaluation. RESULTS: Among 82 confirmed CA, types were immunoglobulin light chain (AL, n = 26), hereditary transthyretin (m-TTR, n = 37) and senile (WT-TTR, n = 19). Compared to those without, CA patients had significantly lower RV fractional shortening (RV-FS), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler systolic velocity, and global RV-LS, without any difference among the CA types. RV-LGE, observed in 62% of CA patients, was associated with lower global and basal RV-FS. Median follow-up was 8(2; 16) months. Using multivariate analysis, NYHA-class and low TAPSE independently predicted major adverse cardiac event (MACE) defined as death, heart transplantation and acute heart failure. Independent determinants of TAPSE < 14 mm, the best cut-off value, were LV ejection fraction (LVEF), estimated filling pressure (E/E'), NT-proBNP and pulmonary artery pressure, but not RV-LGE. CONCLUSIONS: RV dysfunction is common in CA. Its routine evaluation by a simple TAPSE may be an aid in assessing the prognosis of CA patients.
Bodez et al. (Mon,) führten eine Kohorte bei kardialer Amyloidose (n=129) durch. Die Bewertung der systolischen Funktion des rechten Ventrikels (TAPSE) wurde anhand schwerwiegender kardiovaskulärer Ereignisse (MACE) evaluiert, die als Tod, Herztransplantation und akute Herzinsuffizienz definiert sind. Eine Dysfunktion des rechten Ventrikels, die durch ein niedriges TAPSE (< 14 mm) beurteilt wurde, sagte unabhängig schwerwiegende kardiovaskuläre Ereignisse bei Patienten mit kardialer Amyloidose vorher.