Lower left atrial emptying fraction was independently associated with a higher risk of 2-year mortality in systemic light-chain amyloidosis (HR 1.08 per 1% decrease; 95% CI 1.02-1.15; P=0.003).
Cohort (n=54)
Does left atrial emptying fraction (LAEF) assessed by CMR predict 2-year mortality in patients with systemic light-chain amyloidosis?
In patients with systemic light-chain amyloidosis, reduced left atrial emptying fraction assessed by CMR is an independent predictor of 2-year mortality.
Hazard Ratio: 1.08 (95% CI 1.02–1.15)
p-value: p=0.003
BACKGROUND: Cardiac involvement in systemic light-chain amyloidosis (AL) imparts an adverse impact on outcome. The left atrium (LA), by virtue of its anatomical location and muscular wall, is commonly affected by the amyloid process. Although LA infiltration by amyloid fibrils leads to a reduction in its pump function, the infiltration of the left ventricular (LV) myocardium results in diastolic dysfunction with subsequent increase in filling pressures and LA enlargement. Even though left atrial volume (LAV) is an independent prognostic marker in many cardiomyopathies, its value in amyloid heart disease remains to be determined. In addition, few data are available as to the prognostic value of LA function in systemic AL. Using cardiac magnetic resonance (CMR), the current study aims to assess the prognostic significance of the maximal LAV and total LA emptying fraction (LAEF) in patients with AL. METHODS AND RESULTS: Fifty-four consecutive patients (age 66 ± 10 years, 59% males) with confirmed systemic AL and mean LV ejection fraction of 60 ± 12% underwent CMR. As compared with patients with no or minimal cardiac involvement (Mayo Clinic MC stage I), those at moderate and high risk (MC stages II and III) had significantly larger indexed maximal LAV (36 ± 15 vs. 46 ± 13 vs. 52 ± 19 mL/m(2), P = 0.03) and indexed minimal LAV (20 ± 6 vs. 34 ± 11 vs. 44 ± 17 mL/m(2), P 16% (37 ± 11 vs. 94 ± 4%, P = 0.001). In multivariate analysis, lower LAEF remained independently associated with a higher risk of 2-year mortality (HR = 1.08 per 1% decrease, 95% CI: 1.02-1.15, P = 0.003). CONCLUSION: In patients with systemic AL, LAEF as assessed by CMR is associated with NYHA functional class, MC stage, myocardial LGE and 2-year mortality.
Mohty et al. (Wed,) conducted a cohort in Systemic light-chain amyloidosis (AL) (n=54). Lower left atrial emptying fraction (LAEF) vs. Higher LAEF was evaluated on 2-year mortality (HR 1.08, 95% CI 1.02-1.15, p=0.003). Lower left atrial emptying fraction was independently associated with a higher risk of 2-year mortality in systemic light-chain amyloidosis (HR 1.08 per 1% decrease; 95% CI 1.02-1.15; P=0.003).