D-Dimer: A Novel Predictor of Survival in Patients with Cardiac Light- Chain Amyloidosis

Abstract

Background: To identify independent risk factors and predictors of survival in patients with cardiac light chain amyloidosis. Methods: This study included 26 patients with cardiac AL amyloidosis who were diagnosed by biopsy between October 2009 and January 2016. All the patients were followed up until August 26th, 2016. Baseline clinical data including clinical symptoms, laboratory data, and echocardiographic findings were recorded. Univariate and multivariate Cox proportional hazard regression analyses were performed to identify risk factors for all-cause mortality. The Kaplan-Meier method and log-rank test were used to compare survival times. Results: In univariate and multivariate analysis, N-terminal pro b-type natriuretic peptide (NT-proBNP) and Ddimer were independent risk factors for all-cause mortality in patients with cardiac AL amyloidosis (P<0.05). The cutoff value of NT-proBNP for 6-month all-cause-mortality was 4509.5 ng/L (sensitivity 73.3%, specificity 77.8%, area under curve (AUC) 67%, 95% confidence interval (CI) 0.442-0.899). The cut-off value of D-dimer for 6-month allcause- mortality was 1.22 mg/L (sensitivity 60%, specificity 90%, AUC 70%, 95% CI: 0.489-0.911). Patients with NTproBNP or D-dimer levels above the cut-off value had a higher all-cause-mortality rate compared to patients below the cut-off value. Conclusion: D-dimer may be an important biomarker of prognosis in cardiac AL amyloidosis patients.