Left ventriculo-arterial coupling in a contemporary cohort of patients with wild-type transthyretin cardiac amyloidosis treated with tafamidis.

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Research in Cardiology Pub Date : 2026-05-01 Epub Date: 2025-11-03 DOI:10.1007/s00392-025-02727-z

Giuseppe Damiano Sanna, Valeria Anna Di Simone, Paolo Milani, Alessandro Fogliani, Roberta Mussinelli, Gianluigi Guida, Andrea Attanasio, Laura Obici, Marco Basset, Martina Nanci, Andrea Foli, Gavino Casu, Leonardo De Luca, Mario Nuvolone, Giampaolo Merlini, Stefano Perlini, Giovanni Palladini

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引用次数: 0

Abstract

Background: Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is characterized by a labile equilibrium between preload and afterload. A tailored approach to supporting medical therapy based on noninvasive parameters able to describe the properties of both heart and systemic vasculature, and their interactions is required. However, data on ventriculo-arterial coupling (VAC) in ATTRwt-CM is lacking.

Objectives: To describe ventriculo-arterial coupling (VAC) and its clinical correlates in a contemporary cohort of patients with ATTRwt-CM.

Methods: The VAC, defined as the ratio between arterial (E_a) and ventricular elastance (E_es) was evaluated noninvasively using the single-beat algorithm based on arm cuff blood pressure, Doppler stroke volume, pre-ejection time and total ejection time.

Results: The study included 114 patients treated with the transthyretin stabilizer tafamidis from a national referral centre (median age 79 years; 89% males). Median values were 1.48 (1.22-1.84) mmHg/ml for E_a, 1.86 (1.49-2.29) mmHg/ml for E_es, and 1.24 (0.96-1.58) for VAC. Patients with upper-tertile VAC showed worse clinical (National Amyloidosis Centre (NAC)/Mondor stage, p < 0.001), laboratory (NT-pro-B-type natriuretic peptide levels, p < 0.001), instrumental features (left ventricular ejection fraction and stroke volume, p = 0.0001 for both), and they received more intensive heart failure supportive therapies. The E_a/E_es ratio, but not its single components, was associated with NT-proBNP levels. Finally, the E_a/E_es ratio was an independent determinant of a high NAC/Mondor stage at both univariate (OR[95% CI]:15.39[3.51-67.35], p < 0.001) and multivariate (OR[95% CI]:11.26[1.98-63.81], p = 0.006) logistic regression analyses.

Conclusion: In ATTRwt-CM patients, arterial and ventricular elastances and VAC are independent predictors of worse clinical status and more advanced disease stage.

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左心室-动脉耦合在野生型转甲状腺素型心脏淀粉样变性患者的当代队列中。

背景：野生型转甲状腺素淀粉样心肌病（ATTRwt-CM）的特征是前负荷和后负荷之间的不稳定平衡。需要一种量身定制的方法来支持基于非侵入性参数的医学治疗，这些参数能够描述心脏和全身脉管系统的特性及其相互作用。然而，attrt - cm的心室-动脉耦合（VAC）数据缺乏。目的：描述当代attrt - cm患者的心室-动脉耦合（VAC）及其临床相关性。方法：采用基于臂袖带血压、多普勒卒中容积、射血前时间和总射血时间的单拍算法，无创评估动脉弹性（Ea）与心室弹性（Ees）之比。结果：该研究纳入了114例来自国家转诊中心的经甲状腺素稳定剂他法米地治疗的患者（中位年龄79岁，89%为男性）。Ea的中位数为1.48 (1.22-1.84)mmHg/ml， Ees的中位数为1.86 (1.49-2.29)mmHg/ml， VAC的中位数为1.24（0.96-1.58）。上特位型VAC患者表现出更差的临床（国家淀粉样变性中心（NAC））/Mondor分期，p a/Ees比率与NT-proBNP水平相关，但与其单一组分无关。最后，Ea/Ees比率是单因素NAC/Mondor分期高的独立决定因素(OR[95% CI]:15.39[3.51-67.35]， p结论：在attrt - cm患者中，动脉和心室弹性和VAC是临床状况较差和疾病分期较晚的独立预测因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Research in Cardiology 医学-心血管系统

CiteScore

11.40

自引率

4.00%

发文量

140

审稿时长

4-8 weeks

期刊介绍： Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery. As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.