Prognostic value of heart failure hospitalization in transthyretin cardiac amyloidosis: an international cohort study

Background Data on the impact of a heart failure hospitalization (HFH) on outcome in patients with transthyretin cardiac amyloidosis (TTR-CA) are scarce, although it remains a frequent adverse event. Purpose To assess the occurrence of HFH in a real-world TTR-CA population, and the prognosis thereafter. Methods Data were collected from a multicenter TTR-CA registry and patients were dichotomized according to the occurrence of at least one HFH. Landmark analysis at the one-year follow-up and Cox regression analysis with HFH as a time-dependent covariate were performed to assess the impact of HFH on all-cause mortality. Results Overall, 654 patients were included (median age 78(64, 83) years, 71% male, 71% wild type). During a median follow-up of 24(11-45) months, 141(22%) patients experienced at least one HFH and 170(26%) patients died. Patients with HFH were older, had more wild-type TTR-CA, were more symptomatic, had higher National Amyloidosis Centre (NAC) disease stage, were less treated with disease-modifying therapy, had more co-morbidities and showed signs of more advanced disease by echocardiography. At the one-year time point, patients with HFH had significant worse overall survival (Figure). At the univariable (HR 7.710, 95%CI 5.497, 10.815, p<0.001) and multivariable analyses, HFH was associated with all-cause mortality and showed incremental value on top of clinical variables, biomarkers (eGFR and NAC stage) and echocardiographic parameters (LV mass index, stroke volume index, significant valvular lesion and E/e’)(Figure). Conclusion HFH is independently associated with all-cause mortality in patients with TTR-CA and has incremental value on top of established risk models.