Key result
Combined impaired peak VO2 (<50%) and FVC (<70%) strongly predicted MACE in ATTR-CA patients (HR 25.60, 95% CI 4.62-141.85, p<0.01) and improved biomarker risk stratification by 35%.
Why the study?
Traditional biological staging stratifies ATTR-CA severity, but the combined prognostic value of simple spirometry, CPET, and biomarker staging had not been established.
Does combining lung spirometry (FVC) and cardiopulmonary exercise testing (peak VO2) with ATTR biomarker staging improve the prediction of major adverse cardiac events in patients with transthyretin cardiac amyloidosis?
Cohort (n=82)
Yes
Does combining lung spirometry (FVC) and cardiopulmonary exercise testing (peak VO2) with ATTR biomarker staging improve the prediction of major adverse cardiac events in patients with transthyretin cardiac amyloidosis?
Adding simple spirometry (FVC <70%) and CPET (peak VO2 <50%) to traditional biomarker staging improves MACE risk discrimination by 35% and reclassifies 67% of event-prone ATTR-CA patients into higher risk categories.
Answers are grounded in this paper and cite their sources.
May refine MACE risk stratification in ATTR-CA beyond biomarkers; hypothesis-generating and requires prospective validation.
Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized disease that often results in heart failure and death. Traditionally, biological staging systems are used to stratify disease severity. Reduced aerobic capacity has recently been described as useful in identifying higher risk of cardiovascular events and death. Assessment of lung volume via simple spirometry might also hold prognostic relevance. We aimed to assess the combined prognostic value of spirometry, cardiopulmonary exercise testing (CPET) and biomarker staging in ATTR-CA patients in a multi-parametric approach. We retrospectively reviewed patient records with pulmonary function and CPET testing. Patients were followed until study endpoint (MACE: composite of heart-failure-related hospitalization and all-cause death) or censure (1 April 2022). In total, 82 patients were enrolled. Median follow-up was 9 months with 31 (38%) MACE. Impaired peak VO2 and forced vital capacity (FVC) were independent predictors of MACE-free survival, with peak VO2 < 50% and FVC < 70% defining the highest risk group (HR 26, 95% CI: 5–142, mean survival: 15 months) compared to patients with the lowest risk (peak VO2 ≥ 50% and FVC ≥ 70%). Combined peak VO2, FVC and ATTR biomarker staging significantly improved MACE prediction by 35% compared to ATTR staging alone, with 67% patients reassigned a higher risk category (p < 0.01). In conclusion, combining functional and biological markers might synergistically improve risk stratification in ATTR-CA. Integrating simple, non-invasive and easily applicable CPET and spirometry in the routine management of ATTR-CA patients might prove useful for improved risk prediction, optimized monitoring and timely introduction of newer-generation therapies.
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Banydeen et al. (2023) conducted a cohort in Transthyretin cardiac amyloidosis (ATTR-CA) (n=82). Combined impaired peak VO2 (<50% predicted) and reduced forced vital capacity (<70% predicted) vs. Preserved peak VO2 (≥50% predicted) and forced vital capacity (≥70% predicted) was evaluated on Major adverse cardiac events (MACE: composite of heart-failure-related hospitalization and all-cause death) (HR 25.60, 95% CI 4.62-141.85, p=<0.01). Combined impaired peak VO2 (<50%) and FVC (<70%) strongly predicted MACE in ATTR-CA patients (HR 25.60, 95% CI 4.62-141.85, p<0.01) and improved biomarker risk stratification by 35%.
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