Key result
In patients with light chain cardiac amyloidosis, pleural effusion was associated with a 5.6-fold increased risk of cardiac death or heart failure hospitalization in univariable analysis, though it was not an independent predictor after multivariable adjustment.
Why the study?
It was unknown whether pericardial and pleural effusions correlate with right ventricular function in cardiac amyloidosis, and data on their prognostic significance were scarce.
Does the presence of pleural or pericardial effusion correlate with right ventricular function and predict worse clinical outcomes in patients with cardiac amyloidosis?
Cohort (n=143)
No
Does the presence of pleural or pericardial effusion correlate with right ventricular function and predict worse clinical outcomes in patients with cardiac amyloidosis?
Hazard Ratio: 5.604 (95% CI 2.334–13.456)
p-value: p=<0.001
Pleural effusion, but not pericardial effusion, is a marker of poor right ventricular function and worse prognosis in patients with light chain (AL) cardiac amyloidosis.
Pleural effusion may signal worse RV function and outcomes in AL amyloidosis; leaves open subtype-specific prognostic roles and need for prospective validation.
BACKGROUND: Pericardial and pleural effusion are common findings in patients with cardiac amyloidosis (CA). It is not known, whether effusions correlate with right ventricular (RV) function in these patients. Furthermore, data on the prognostic significance of pleural and pericardial effusion in CA is scarce. METHODS: Patients with transthyretin (ATTR) and light chain (AL) CA were included in a clinical registry. All patients underwent transthoracic echocardiography at baseline. The presence of pericardial and pleural effusion was determined in every patient. The clinical endpoint was defined as cardiac death or heart failure hospitalization. RESULTS: In total, 143 patients were analysed. Of these, 85 patients were diagnosed with ATTR and 58 patients with AL. Twenty-four patients presented with isolated pericardial effusion and 35 with isolated pleural effusion. In 19 patients, both pericardial and pleural effusion were found and in 65 patients no effusion was present at baseline. The presence of pleural effusion correlated well with poor RV function, measured by global RV free-wall strain (p = 0.007) in patients with AL, but not in ATTR. No such correlation could be found for pericardial effusion in either amyloidosis subtype. Patients with AL presenting with pleural effusion had worse outcomes compared to patients with pericardial effusion alone or no effusion at baseline. In the ATTR group, there was no difference in outcomes according to presence and type of effusion. CONCLUSION: More than 50% of patients with CA presented with pleural and/or pericardial effusions. While pleural effusion was clearly associated with poor RV function in AL, we were not able to detect this association with pericardial effusion.
No takes yet. Share an insight, caveat, or question.
Binder et al. (2020) conducted a cohort in Cardiac amyloidosis (n=143). Pleural effusion vs. No effusion or isolated pericardial effusion was evaluated on Cardiac death or heart failure hospitalization (HR 5.604, 95% CI 2.334-13.456, p=<0.001). In patients with light chain cardiac amyloidosis, pleural effusion was associated with a 5.6-fold increased risk of cardiac death or heart failure hospitalization in univariable analysis, though it was not an independent predictor after multivariable adjustment.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: