Prognostic Utility of Left Atrial Strain to Predict Thrombotic Events and Mortality in Amyloid Cardiomyopathy.

IF 1.2 2区数学 Q1 MATHEMATICS

Transactions of the American Mathematical Society Pub Date : 2023-11-01 Epub Date: 2023-04-12 DOI:10.1016/j.jcmg.2023.01.015

Emmanuel Akintoye, Muhammad Majid, Allan L Klein, Mazen Hanna

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引用次数: 2

Abstract

Background: There is currently no thromboembolic risk stratification tool for amyloid cardiomyopathy (ACM) and the current survival staging systems for ACM have only modest discriminatory ability.

Objectives: This study aims to evaluate the prognostic value of left atrial (LA) strain to predict incident thrombotic event (TE) and improve survival staging systems in ACM.

Methods: The authors identified patients with light chain (AL) or transthyretin (ATTR) ACM and no history of atrial fibrillation (AF) at diagnosis. Three components of LA strain (reservoir, conduit, and contractile) were measured and their predictive value for TE and mortality was determined. In addition, the authors evaluated the incremental utility of adding LA strain to current prognostic staging systems.

Results: The authors included 448 patients (50.2% AL; 49.8% ATTR) with median follow-up of 3.8 years. There were 64 (14.3%) TE cases, 103 (23%) AF cases, and 234 (52.2%) deaths. Notably, 75% of TEs occurred without preceding AF documented. LA strain reservoir and LA contractile strain significantly predicted both events: HRs for TE were 2.22 (95% CI: 1.27-3.85; P = 0.006) and 2.63 (95% CI: 1.25-5.00; P = 0.01) per SD decrease in LA strain reservoir and LA contractile strain, respectively. The respective HRs for mortality were 1.32 (95% CI: 1.09-1.59; P < 0.001) and 1.49 (95% CI: 1.22-1.75; P < 0.001). Also, LA strain reservoir and LA contractile strain significantly improved the C-statistics of the Mayo AL staging from 0.65 to 0.68 and 0.70, respectively (P ≤ 0.02); Mayo ATTR staging (0.73 to 0.79 and 0.80, respectively; P < 0.001); and Gillmore ATTR staging (0.70 to 0.79 and 0.80, respectively; P < 0.001).

Conclusions: LA strain identifies ACM patients with high thrombotic risk (independent of AF) and improves current ACM-specific survival staging.

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左心房应变对预测淀粉样心肌病血栓事件和死亡率的预后作用

背景：目前还没有针对淀粉样变性心肌病（ACM）的血栓栓塞风险分层工具，而且目前针对ACM的生存分期系统也只有适度的鉴别能力：本研究旨在评估左心房（LA）应变的预后价值，以预测血栓事件（TE）并改进 ACM 的生存分期系统：作者确定了轻链（AL）或转甲状腺素（ATTR）ACM 患者，诊断时无心房颤动（AF）病史。作者测量了 LA 应变的三个组成部分（储库、导管和收缩性），并确定了它们对 TE 和死亡率的预测价值。此外，作者还评估了在当前预后分期系统中增加 LA 应变的增量效用：作者共纳入 448 名患者（50.2% AL；49.8% ATTR），中位随访时间为 3.8 年。其中64例（14.3%）TE，103例（23%）AF，234例（52.2%）死亡。值得注意的是，75%的TE发生前无房颤记录。LA 应变库和 LA 收缩应变可显著预测这两种事件：LA 应变库和 LA 收缩应变每减少 SD，TE 的 HR 分别为 2.22（95% CI：1.27-3.85；P = 0.006）和 2.63（95% CI：1.25-5.00；P = 0.01）。死亡率的 HR 分别为 1.32（95% CI：1.09-1.59；P <0.001）和 1.49（95% CI：1.22-1.75；P <0.001）。此外，LA应变储库和LA收缩应变还能显著改善梅奥AL分期的C统计量，分别从0.65升至0.68和0.70（P≤0.02）；梅奥ATTR分期（分别从0.73升至0.79和0.80；P＜0.001）；以及Gillmore ATTR分期（分别从0.70升至0.79和0.80；P＜0.001）：结论：LA 应变可识别血栓形成风险高的 ACM 患者（与房颤无关），并改善当前 ACM 特异性生存分期。

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

Transactions of the American Mathematical Society 数学-数学

CiteScore

2.30

自引率

7.70%

发文量

171

审稿时长

3-6 weeks

期刊介绍： All articles submitted to this journal are peer-reviewed. The AMS has a single blind peer-review process in which the reviewers know who the authors of the manuscript are, but the authors do not have access to the information on who the peer reviewers are. This journal is devoted to research articles in all areas of pure and applied mathematics. To be published in the Transactions, a paper must be correct, new, and significant. Further, it must be well written and of interest to a substantial number of mathematicians. Piecemeal results, such as an inconclusive step toward an unproved major theorem or a minor variation on a known result, are in general not acceptable for publication. Papers of less than 15 printed pages that meet the above criteria should be submitted to the Proceedings of the American Mathematical Society. Published pages are the same size as those generated in the style files provided for AMS-LaTeX.