One-year worsening heart failure and myocardial T1 mapping in patients with wild-type transthyretin amyloid cardiomyopathy undergoing tafamidis treatment

Figures

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  Fig. 1. Study flowchart. ATTR-CM − transthyretin amyloid cardiomyopathy; CMR − cardiovascular magnetic resonance; WHF − worsening heart failure.

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  Fig. 2. Optimal cutoff values in predicting WHF and Kaplan–Meier curves for WHF. (A) The receiver operating characteristic curve of T1native for predicting WHF. (B) The receiver operating characteristic curve of ECV for predicting WHF. (C) Kaplan–Meier curve for WHF stratified by the optimal cutoff value of T1native. (D) Kaplan–Meier curve for WHF stratified by the optimal cutoff value of ECV. AUC − area under the curve; ECV − extracellular volume fraction; T1native − native myocardial T1 value; WHF − worsening heart failure.

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  Fig. 3. Representative ATTR-CM patients with and without WHF. (A) This patient was an 80-year-old male, and classified as Mayo stage II at baseline. The baseline T1native and ECV were 1487 ms and 60.3 %, respectively. This patient received intensified diuretic therapy (increase in loop diuretic dose) due to symptoms of decompensated heart failure 10 months after the initiation of tafamidis treatment. (B) This patient was a 73-year-old male, and classified as Mayo stage III at baseline. The baseline T1native and ECV were 1411 ms and 47.6 %, respectively. This patient experienced no WHF over the one-year period after the initiation of tafamidis treatment. ATTR-CM − transthyretin amyloid cardiomyopathy; ECV − extracellular volume fraction; T1native − native myocardial T1 value; WHF − worsening heart failure.

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  Fig. 4. Comparison of myocardial T1 mapping parameters between baseline and follow-up CMR. Both T1native (A) and ECV (B) remained entirely unchanged between baseline and follow-up imaging. Nevertheless, a significant proportion of patients exhibited a reduction in these parameters after one year of tafamidis treatment. CMR − cardiac magnetic resonance; ECV − extracellular volume fraction; T1native − native myocardial T1 value.

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  Fig. 5. Correlations between changes in myocardial T1 mapping parameters after tafamidis treatment and their baseline values or post-treatment changes in cardiac biomarkers. (A and B) The changes inT1native and ECV exhibited a negative correlation with their respective baseline values. (C-F) The change in T1native exhibited a positive correlation with the post-treatment change in serum NT-proBNP concentration. No other correlations were observed between post-treatment changes in T1 mapping parameters and cardiac biomarkers. ECV − extracellular volume fraction; hs-cTnT − high-sensitivity cardiac troponin T; NT-proBNP − N-terminal pro-B-type natriuretic peptide; T1native − native myocardial T1 value.