Key result
Monoclonal gammopathy of uncertain significance (MGUS) was present in 13% of patients with HFpEF without hypertrophy, but was not significantly associated with the composite endpoint of heart failure readmission or death compared to patients without MGUS (22.2% vs 36.7%, p=0.403).
Why the study?
HFpEF and monoclonal gammopathy of uncertain significance share pathophysiological mechanisms, but the prevalence and prognostic value of MGUS in HFpEF without LV hypertrophy remained unestablished.
Does the presence of MGUS affect the composite of readmission for heart failure or death in patients with HFpEF without left ventricular hypertrophy?
Observational (n=69)
No
Does the presence of MGUS affect the composite of readmission for heart failure or death in patients with HFpEF without left ventricular hypertrophy?
Absolute Event Rate: 22.2% vs 36.7%
p-value: p=0.403
In patients with HFpEF without significant LV hypertrophy, MGUS is three times more prevalent than in the general population but does not significantly impact 12-month clinical outcomes.
MGUS does not predict 12-month HF readmission or death in this cohort; leaves open need for larger studies with longer follow-up.
BACKGROUND: Heart failure (HF) with preserved ejection fraction (HFpEF) and monoclonal gammopathy of uncertain significance (MGUS) are two entities that share pathophysiological mechanisms. The aim herein, was to assess the prevalence of MGUS in patients with HFpEF and no left ventricular (LV) hypertrophy, as well as its association with a pre-specified clinical endpoint at 12 months. METHODS: The present study prospectively enrolled 69 patients admitted with HF, with ejection fraction ≥ 50%, and LV wall thickness < 12 mm. All patients were screened for MGUS. Clinical events were determined over a 12 month follow-up. The pre-specified composite clinical endpoint was readmission for HF or death. RESULTS: The prevalence of MGUS in this population was 13%. There were no differences in the incidence of the composite clinical endpoint between patients with and without MGUS. Multivariate analysis showed that treatment with angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) was associated with fewer clinical events (HR: 0.153, 95% CI: 0.037-0.622, p = 0.009) and indicated a trend to lower risk of readmission for HF and death. Beta-blockers were associated with lower rates of the composite clinical endpoint (HR: 0.192, 95% CI: 0.05-0.736, p = 0.016), readmission for HF (HR: 0.272, 95% CI: 0.087-0.851, p = 0.025) and indicated a trend to lower mortality. Moreover, potassium serum levels > 5 mEq/L were associated with higher rates of the composite endpoint (HR: 6.074, 95% CI: 1.6-22.65, p = 0.007). CONCLUSIONS: The prevalence of MGUS in patients with HFpEF without hypertrophy was 3-fold that of the general population. There was no significant correlation between clinical outcomes and the presence of MGUS. Beta-blockers and ACEIs/ARBs reduced the composite of mortality and readmissions for HF in HFpEF patients. Hyperpotassemia was related to worse prognosis.
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A 2020 study conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=69). Monoclonal gammopathy of uncertain significance (MGUS) vs. No MGUS was evaluated on Composite of readmission for heart failure or death (p=0.403). Monoclonal gammopathy of uncertain significance (MGUS) was present in 13% of patients with HFpEF without hypertrophy, but was not significantly associated with the composite endpoint of heart failure readmission or death compared to patients without MGUS (22.2% vs 36.7%, p=0.403).
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