Effusion Linked to Ventricular Function and Prognosis in Cardiac Amyloidosis

A study published in Blood Cancer Journal found that pleural effusion was strongly associated with poor right ventricular (RV) function in patients with cardiac amyloidosis (CA), although they were not able to detect this association with pericardial effusion.

More than half of patients with CA present with pleural and/or pericardial effusions, which is marked by an excessive buildup of fluid around the lungs or heart. It is not clear whether effusions correlate with RV function in this patient population, and data on the prognostic significance are scarce.

Researchers from the Medical University of Vienna in Austria, created a clinical registry of patients with transthyretin (ATTR) and light-chain (AL) CA to assess effusion characteristics and prognosis. Of 143 patients, 85 (59.4%) presented with ATTR and 58 (40.6%) with AL. All patients underwent transthoracic echocardiography at baseline, and follow-up was conducted every six months. The clinical endpoint was cardiac death or heart failure hospitalization.

At baseline, 35 patients (24.5%) presented with isolated pleural effusion, 24 (16.8%) with isolated pericardial effusion, and 19 (13.3%) with both pleural and pericardial effusion. No effusion was present in 65 patients (45.5%).

The researchers found that pleural effusion correlated with poor RV function in patients with AL (P=0.007), but not in patients with ATTR amyloidosis. AL patients with pleural effusions were also found to have higher amyloid burden. There was no correlation found between impaired RV function and pericardial effusion in either amyloidosis subtype.

Overall, patients with AL presenting with pleural effusion had worst outcomes compared with patients with pericardial effusion alone or no effusion at baseline. There was no difference in outcomes according to presence or type of effusion in the ATTR group.

“Pericardial and pleural effusions are present in more than 50% of patients with CA, and assessment of effusion should be included in standard echocardiographic examination of all patients with suspected or definite diagnosis of CA. Pleural but not pericardial effusions were associated with adverse cardiac outcomes,” the researchers concluded.