Right Heart Function May Predict Survival for Cardiac Amyloidosis Patients

Right heart evaluation may be considered a marker for clinical risk stratification in patients with cardiac amyloidosis (CA), according to results from a single-center study.

Amyloidosis is an immune system disorder that occurs due to the deposition of an excessive amount of amyloid proteins in parenchymal tissues, including the myocardium. Cardiac involvement dramatically worsens functional capacity and prognosis for amyloid patients.

In this retrospective study, a team of researchers from Italy analyzed 135 patients who were treated for systemic amyloidosis between 1981 and 2019. Among them, 54 patients presented with CA at baseline. In 53 patients, amyloidosis was associated with multiorgan involvement, and one patient experienced primary myocardial deposition. Of 54 patients with CA, 44 had light-chain or primary, five had secondary, and three had transthyretin amyloidosis. The researchers enrolled 81 patients without CA as a control group.

Patients with CA were found to have an increased interventricular septum thickness, increased lactate dehydrogenase (LDH) levels, and decreased ejection fraction compared with patients without CA. These patients also had an enhanced right atrium area, right ventricle basal diameter, and wall thickness compared with the control group.

The investigators evaluated patients’ right heart systolic function via tricuspid annular plane systolic excursion (TAPSE). Very poor TAPSE levels were found in the CA cohort compared with the non-CA arm. Patients with CA had very poor survival rates compared with the controls (30 vs. 66 months, respectively; P=0.15). Overall, decreased right heart systolic function was correlated with a worse prognosis.

“Our data highlight the potential prognostic and predictive value of right heart alterations characterizing amyloidosis, as a novel clinical parameter correlated to increased LDH and immunoglobulins levels. Overall, we confirm the clinical relevance of cardiac involvement suggests that right heart evaluation may be considered as a new marker for clinical risk stratification in patients with amyloidosis,” the researchers concluded.

This study was published in Life.