In cardiac amyloidosis, right atrial pressure >14 mm Hg (HR 1.59; 95% CI 1.26-2.00) and reduced cardiac index independently predicted adverse outcomes, outperforming classic hemodynamic cutoffs.
Cohort (n=469)
Do specific hemodynamic cutoffs from right heart catheterization predict adverse outcomes in patients with cardiac amyloidosis?
In cardiac amyloidosis, reduced cardiac index is the strongest hemodynamic predictor of adverse outcomes, while right atrial and pulmonary artery pressures require higher-than-classic thresholds to provide prognostic value.
Effect estimate: HR 1.59 (95% CI 1.26-2.00)
p-value: p=<0.05
Background: Little information is available on the prognostic relevance of cardiac hemodynamic cutoffs in cardiac amyloidosis (CA) and its subtypes. Methods: Consecutive patients diagnose with light chain-CA or transthyretin CA undergoing right heart catheterization were analyzed. Prognostic relevance of classic hemodynamic cutoffs of cardiac index (CI 18 mm Hg), right atrial pressure (>8 mm Hg), and mean pulmonary artery pressure (≥25 mm Hg or pulmonary hypertension) with the combined end point of cardiac transplant/left ventricular assist device and death and heart failure admissions separately was assessed. Results: A total of 469 CA patients underwent right heart catheterization (light chain CA=42% and transthyretin CA=52%) of whom 69%, 64%, and 79% had elevated right atrial pressure, pulmonary capillary wedge pressure, and pulmonary hypertension, respectively. The classic hemodynamic cutoffs for right atrial pressure (hazard ratio, 1.26 0.98–1.62) and mean pulmonary artery pressure (hazard ratio, 1.28 0.96–1.71) did not identify patients at higher risk for adverse outcome; however, cutoffs of 14 mm Hg for right atrial pressure (hazard ratio, 1.59 1.26–2.00) and 35 mm Hg for mean pulmonary artery pressure (hazard ratio, 1.30 1.01–1.66) performed better to detect worse outcome ( P <0.05 for both). Reduced CI occurred in 55% of patients and was the strongest variable associated with the risk for cardiac transplant/left ventricular assist device and death, heart failure admissions, and reduced functional capacity. Reduced CI independently predicted risk on top of the Mayo-score in light chain CA and National Amyloid Center score in transthyretin CA ( P <0.05 for both). Patients with light chain CA had higher pulmonary capillary wedge pressure and lower stroke volume index but maintained CI through a higher heart rate. Conclusions: Hemodynamic variables are grossly abnormal in CA, but elevated filling pressures are prognostic at significantly higher threshold values than classic cutoff values. CI is the hemodynamic variable most strongly associated with outcome and functionality in CA.
Martens et al. (Wed,) conducted a cohort in Cardiac amyloidosis (n=469). Hemodynamic profiling vs. Classic hemodynamic cutoffs was evaluated on Combined end point of cardiac transplant/left ventricular assist device and death (HR 1.59, 95% CI 1.26-2.00, p=<0.05). In cardiac amyloidosis, right atrial pressure >14 mm Hg (HR 1.59; 95% CI 1.26-2.00) and reduced cardiac index independently predicted adverse outcomes, outperforming classic hemodynamic cutoffs.
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