Usefulness of Combining Electrocardiographic and Echocardiographic Findings and Brain Natriuretic Peptide in Early Detection of Cardiac Amyloidosis in Subjects With Transthyretin Gene Mutation

Bella, Gianluca Di; Minutoli, Fabio; Piaggi, Paolo; Casale, Matteo; Mazzeo, Anna; Zito, Concetta; Oreto, Giuseppe; Baldari, Sergio; Vita, Giuseppe; Pingitore, Alessandro; Khandheria, Bijoy K.; Carerj, Scipione

doi:10.1016/j.amjcard.2015.07.008

Cited by 32 publications

(19 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With respect to the biomarkers, although it has been reported that the measurement of NT-proBNP, BNP, and cardiac troponins is informative for the diagnosis of CA and risk stratification of AL amyloidosis, 5,20,25) we showed here that the diagnostic utility of BNP for detecting CA in patients with AL amyloidosis was superior to NT-proBNP and cardiac troponins. 7) Pre-pro BNP, which consists of 134 amino acids, was synthesized through the transcriptional activation of the Nppb gene.…”

Section: Discussionmentioning

confidence: 55%

“…Other abnormalities such as LV thickening and diastolic dysfunction estimated by E/A and E/e' were seen in the CA patients, as reported in previous studies. 8,20) LV global systolic function is maintained until the late stage of CA (24). Although LVEF was significantly lower in the CA group than in the non-CA group, the CA patients showed a mean LVEF of 49.3%, suggesting that most of the CA patients had relatively preserved left ventricular systolic function.…”

Section: Discussionmentioning

confidence: 92%

“…Our diagnosis of CA seems to be more precise and reliable compared to those of previous studies. 1,7,20) Previous studies showed that electrocardiographic abnormalities such as low-voltage complexes (56%), 21) abnormal Q (44%), poor R progression (44%), 20) and AF UTILITY OF BNP IN CARDIAC AMYLOIDOSIS (20%) 22) were found in most patients with CA. In the present study, histologically diagnosed CA patients presented similar ECG abnormalities; however, their frequency of AF was somewhat low (6.7%).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the small number of patients in this study, it was unavoidable as CA is a relatively rare disease; however, previous studies enrolled fewer patients than the current study. 1,20) In the present study, all patients with AL amyloidosis were diagnosed histologically. Although most patients in the CA group were diagnosed histologically based on myocardial biopsy, the patients in the non-CA group did not undergo myocardial biopsy in the current study.…”

Section: Study Limitationsmentioning

confidence: 96%

See 3 more Smart Citations

Utility of B-Type Natriuretic Peptide for Detecting Cardiac Involvement in Immunoglobulin Amyloidosis

et al. 2019

View full text Add to dashboard Cite

A useful biomarker for detecting cardiac amyloidosis (CA) has not been fully established. We aimed to investigate the utility of several biomarkers to detect CA in patients with amyloid light-chain (AL) amyloidosis.We examined the plasma levels of B-type natriuretic peptide (BNP), N-terminal fragment of the pro-brain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), serum amyloid A, and the difference between kappa and lambda free light chain (dFLC) between CA patients (n = 30, 47.6%) and non-CA patients (n = 33, 52.4%). Levels of BNP were significantly higher in the CA group compared to the non-CA group (1200.0 versus 224.0 pg/mL, P = 0.001). From the ROC analysis, the sensitivity and specificity of BNP for detecting CA (with a cut-off value of 412 pg/mL) were 83% and 70%, respectively, and the area under the receiver operating curve was 0.75 (95% CI 0.61-0.90, P < 0.001) in all AL amyloidosis patients (n = 63). In contrast, other markers such as NT-proBNP, hs-cTnT, serum amyloid A, and dFLC were not useful for detecting CA in AL amyloidosis patients. Additionally, in the Cox proportional hazard analysis, BNP was a predictor of all-cause mortality (hazard ratio 3.266, 95% confidence interval 1.498-7.119, P = 0.003).BNP is a useful biomarker for detecting cardiac involvement and predicting prognosis in AL amyloidosis patients.

show abstract

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 96%

See 2 more Smart Citations

Utility of B-Type Natriuretic Peptide for Detecting Cardiac Involvement in Immunoglobulin Amyloidosis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Typical amyloidosisrelated electrocardiogram findings, that is, low voltages and advanced atrioventricular blocks, were not prominent, and evident echocardiographic abnormalities were also absent in most of these patients at presentation. 19 Of note, the criteria of cardiac involvement used in this study were a little less stringent than those used by Rapezzi et al 7 In our study, cardiac hypertrophy was defined as an interventricular septum or posterior wall thickness of >11 mm or when right ventricular hypertrophy (>6 mm) was present, whereas in the study of Rapezzi et al right ventricular dimensions were not included in the definition, and a thickness of 13 mm or greater was used for the left ventricle. In our opinion, especially the wall thickness cutoff criteria of our study are more in line with regard to the current echocardiography guidelines.…”

Section: Discussionmentioning

confidence: 99%

Frequency of and Prognostic Significance of Cardiac Involvement at Presentation in Hereditary Transthyretin-Derived Amyloidosis and the Value of N-Terminal Pro-B-Type Natriuretic Peptide

Klaassen

Tromp

Nienhuis

et al. 2018

The American Journal of Cardiology

View full text Add to dashboard Cite

The aim of this study is to assess the prevalence of cardiac involvement in hereditary transthyretin-derived (ATTRm) amyloidosis at the time of diagnosis and to determine the diagnostic and clinical value of N-terminal pro-B-type natriuretic peptide (NT-proBNP). The University Medical Center Groningen is the national center of expertise for amyloidosis. All consecutive patients between 1994 and 2016 with ATTRm amyloidosis were followed prospectively. Baseline was set at the time of the first positive biopsy. All patients underwent a standard cardiac and neurologic work-up. Cardiac involvement was defined by otherwise unexplained left and/or right ventricular wall hypertrophy on cardiac ultrasound and/or advanced conduction disturbances. Seventy-seven patients had ATTRm amyloidosis and were included in the study. The TTR V30M mutation was present in 30 patients (39%). In both the V30M and the non-V30M groups, the neurologic presentation dominated (77% vs 51%), whereas cardiac presentation was infrequent (7% vs 15%). Clinical work-up showed that cardiac involvement was present at baseline in 51% of all patients irrespective of genotype and was associated with increased overall mortality (hazard ratio 5.95, 95% confidence interval 2.12 to 16.7), independent from clinical confounders. At a cutoff level of 125 ng/L, NT-proBNP had a sensitivity of 92% for establishing cardiac involvement. In conclusion, irrespective of the frequent noncardiac presentation of ATTRm amyloidosis, cardiac involvement is already present at diagnosis in half of the patients and is associated with increased mortality. NT-proBNP is a useful marker to determine cardiac involvement in this disease.

show abstract

Clinical characteristics and natural history of wild‐type transthyretin amyloid cardiomyopathy in Japan

et al. 2020

View full text Add to dashboard Cite

Aims The focus on wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is increasing because of novel treatment options. There is currently no report on a large number of Japanese patients with ATTRwt-CM. The study aimed to examine the characteristics and prognosis of ATTRwt-CM in Japan. Methods and results Consecutive patients (78.5 ± 6.4 years old at diagnosis) with ATTRwt-CM diagnosed at Kumamoto University Hospital between December 2002 and December 2019 were retrospectively reviewed. Data, including demographic characteristics, co-morbidities, clinical manifestations at diagnosis, laboratory results, electrocardiographic and echocardiographic data, imaging and pathological findings, and treatment were obtained. Of 129 patients included in this study, 110 patients (85%) were male. The median period from initial symptom onset to diagnosis was 15.5 (2-75) months. Heart failure was the most common clinical manifestation leading to diagnosis (61%) and initial manifestations (49%). Of 106 patients, carpal tunnel syndrome was observed in 57 patients (54%), and the median period from initial symptom onset to diagnosis was 96 (48-120) months. Histopathological confirmation of transthyretin amyloid was achieved in 94 patients (73%), including 66 (51%) and 28 cases (22%) with endomyocardial and extracardiac biopsies. During the observation period (median 15.0 [inter-quartile range, 5.4-33.2] months after diagnosis), 34 patients (26%) died. Of these, 27 patients (79%) had cardiovascular deaths (heart failure, 25; sudden death, two). The median survival duration was 58.9 months and the 5 years' survival rate was 48%. According to a multivariate Cox hazard analysis, age [hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.05-1.23, P = 0.002] and low serum sodium levels (HR, 0.89; 95% CI, 0.79-0.996; P = 0.04) contributed to all-cause mortality, and low serum sodium levels contributed to hospitalization for heart failure (HR, 0.86; 95% CI, 0.77-0.96; P = 0.005). Conclusions Clinical characteristics and prognosis of ATTRwt-CM patients in Japan were examined. Carpal tunnel syndrome can be considered an indication for diagnosis of ATTRwt-CM. Age and low serum sodium level were significant predictive factors of all survival outcomes. The clinical features of ATTRwt-CM should be recognized to provide appropriate treatment.

show abstract

Usefulness of Combining Electrocardiographic and Echocardiographic Findings and Brain Natriuretic Peptide in Early Detection of Cardiac Amyloidosis in Subjects With Transthyretin Gene Mutation

Cited by 32 publications

References 25 publications

Utility of B-Type Natriuretic Peptide for Detecting Cardiac Involvement in Immunoglobulin Amyloidosis

Utility of B-Type Natriuretic Peptide for Detecting Cardiac Involvement in Immunoglobulin Amyloidosis

Frequency of and Prognostic Significance of Cardiac Involvement at Presentation in Hereditary Transthyretin-Derived Amyloidosis and the Value of N-Terminal Pro-B-Type Natriuretic Peptide

Clinical characteristics and natural history of wild‐type transthyretin amyloid cardiomyopathy in Japan

Contact Info

Product

Resources

About