In ATTR amyloidosis, patients with LACI >0.78 had significantly worse survival free from death/HF hospitalization than those with LACI ≤0.78 (p=0.006).
Does a higher left atrio-ventricular coupling index (LACI) predict the composite of all-cause death and/or heart failure hospitalization in patients with transthyretin amyloidosis?
The left atrio-ventricular coupling index (LACI) is a feasible echocardiographic marker that can improve early risk stratification and predict adverse outcomes in patients with transthyretin amyloidosis.
Absolute Event Rate: 0% vs 0%
Abstract Background Transthyretin amyloidosis (ATTR) is a progressive infiltrative cardiomyopathy associated with extracellular amyloid deposition, leading to myocardial dysfunction, diastolic impairment, and restrictive heart failure (HF). Clinical and echocardiographic prognostic parameters have been described in the literature, mainly NAC score consisting of eGFR end NT-pro-BNP as well as strain deformation imaging parameters. Limited data exist for the potential value of left atrio-ventricular coupling index (LACI). Methods We retrospectively analyzed 341 patients diagnosed with wild-type (ATTRwt) and hereditary (ATTRv) TTR amyloidosis who underwent clinical, laboratory and comprehensive echocardiographic assessment. LACI was calculated with conventional echocardiography as the ratio of left atrial minimal volume (measured at the end of LV diastole) divided by the left ventricular end-diastolic volume (LVEDV). Higher LACI values indicate more advanced diastolic dysfunction and greater impairment of left atrioventricular coupling, since left atrium is disproportionately enlarged compared to the left ventricle. To our knowledge, patients with amyloidosis have been excluded from previous studies that evaluate the role of LACI in patients with HF. Results The mean age of patients was 83 years old and 85% were males. In our cohort, 95% of patients had wild-type (ATTRwt) and 5% had hereditary-type (ATTRv) transthyretin amyloidosis. Median NT-pro-BNP was 2432 (interquartile range IQR 977-4436) pg/ml and mean eGFR was 60 (IQR 46-75) ml/min/1.73m2. Patients were more frequently in NYHA class II (62%) and III (24%). According to NAC score, 52% were in NAC stage I, 30% in NAC stage II and 18% in NAC stage III. During a median follow-up of 22 months (IQR 8-40 months), there were 114 deaths and 66 hospitalizations for acute decompensated heart failure. 133 patients (39%) reached the composite endpoint of all-cause death and/or heart failure hospitalization. LACI calculation was feasible in 323 patients and the median value was 0.78 (IQR 0.56-1.05). Patients were divided in two groups based on the median LACI. One hundred sixty patients had LACI 0.78 and 75 of them died during follow-up, whereas 163 patients had LACI ≤0.78 and 51 died during follow-up. The survival free from the composite endpoint was significantly better in patients with LACI ≤0.78 vs 0.78, p=0.006 (Fig.1). Conclusion This study highlights the potential value of LACI in patients with ATTR cardiomyopathy. The integration of this echocardiographic marker could improve early risk stratification and treatment selection in these patients, since greater values of LACI reflect more advanced diastolic dysfunction. Future prospective studies are needed to evaluate the impact of LACI on patients’ prognosis.Figure 1
Zygouri et al. (Sat,) reported a other. In ATTR amyloidosis, patients with LACI >0.78 had significantly worse survival free from death/HF hospitalization than those with LACI ≤0.78 (p=0.006).