European Heart Journal Open最新文献

{"title":"Predicting poor neurological outcomes following out-of-hospital cardiac arrest using neuron-specific enolase and neurofilament light chain in patients with and without haemolysis.","authors":"Yusuf Abdi Isse,&nbsp;Ruth Frikke-Schmidt,&nbsp;Sebastian Wiberg,&nbsp;Johannes Grand,&nbsp;Laust E R Obling,&nbsp;Anna Sina Pettersson Meyer,&nbsp;Jesper Kjaergaard,&nbsp;Christian Hassager,&nbsp;Martin A S Meyer","doi":"10.1093/ehjopen/oead078","DOIUrl":"https://doi.org/10.1093/ehjopen/oead078","url":null,"abstract":"<p><strong>Aims: </strong>Hypoxic-ischaemic brain injury following out-of-hospital cardiac arrest (OHCA) is a common complication and a major cause of death. Neuron-specific enolase (NSE) and neurofilament light chain (NfL) are released after brain injury and elevated concentrations of both are associated with poor neurological outcome. We explored the influence of haemolysis on the prognostic performance of NSE and NfL.</p><p><strong>Methods and results: </strong>The study is based on <i>post hoc</i> analyses of a randomized, single-centre, double-blinded, controlled trial (IMICA), where comatose OHCA patients of presumed cardiac cause were included. Free-haemoglobin was measured at admission to quantify haemolysis. NSE and NfL were measured after 48 h to estimate the extent of brain injury. Montreal Cognitive Assessment score (MoCA) was assessed to evaluate neurocognitive impairments. Seventy-three patients were included and divided into two groups by the median free-haemoglobin at admission. No group differences in mortality or poor neurological outcome were observed. The high-admission free-haemoglobin group had a significantly higher concentration of NSE compared to the low-admission free-haemoglobin group (27.4 µmol/L vs. 19.6 µmol/L, <i>P</i> = 0.03), but no differences in NfL. The performance of NSE and NfL in predicting poor neurological outcome were high for both, but NfL was numerically higher [area under the ROC (AUROC) 0.90 vs. 0.96, <i>P</i> = 0.09]. Furthermore, NfL, but not NSE, was inversely correlated with MoCA score, <i>R</i>² = 0.21, <i>P</i> = 0.006.</p><p><strong>Conclusion: </strong>High free-haemoglobin at admission was associated with higher NSE concentration after 48 h, but, the performance of NSE and NfL in predicting poor neurological outcome among OHCA patients were good regardless of early haemolysis. Only elevated NfL concentrations were associated with cognitive impairments.</p>","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 4","pages":"oead078"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10475903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aetiology and outcome in hospitalized cardiac arrest patients.","authors":"Malin Albert, Johan Herlitz, Araz Rawshani, Sune Forsberg, Mattias Ringh, Jacob Hollenberg, Andreas Claesson, Meena Thuccani, Peter Lundgren, Martin Jonsson, Per Nordberg","doi":"10.1093/ehjopen/oead066","DOIUrl":"10.1093/ehjopen/oead066","url":null,"abstract":"<p><strong>Aims: </strong>To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival.</p><p><strong>Methods and results: </strong>Observational study with data from national registries. Specific aetiologies (<i>n</i> = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance Category scale 1-2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (<i>P</i> < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13).</p><p><strong>Conclusion: </strong>In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.</p>","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 4","pages":"oead066"},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9976151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of phenprocoumon with direct oral anticoagulants in catheter ablation of atrial fibrillation.","authors":"Diona Gjermeni, Nertila Poci Saglam, Christoph B Olivier, Volker Kühlkamp","doi":"10.1093/ehjopen/oead065","DOIUrl":"10.1093/ehjopen/oead065","url":null,"abstract":"<p><strong>Aims: </strong>In patients undergoing catheter ablation for atrial fibrillation (AF), direct oral anticoagulants (DOACs) are as effective and safe as the vitamin K antagonist (VKA) warfarin. Phenprocoumon has a different pharmacokinetic profile compared with warfarin and is the most used VKA in Germany. The aim of the study was to compare DOAC with phenprocoumon.</p><p><strong>Methods and results: </strong>In this retrospective single-centre cohort study, 1735 patients who underwent 2219 consecutive catheter ablations for AF between January 2011 and May 2017 were included. All patients were in-hospital for at least 48 h after catheter ablation. The primary outcome was defined as peri-procedural thrombo-embolic events. The secondary outcome was any bleeding according to the International Society on Thrombosis and Haemostasis (ISTH). The mean age of the patients was 63.3 years. Phenprocoumon was prescribed in 929 (42%) of the cases, and in 697 (31%) dabigatran, 399 (18%) rivaroxaban, and 194 (9%) apixaban. During hospitalization, 37 (1.6%) thrombo-embolic events occurred, including 23 transient ischaemic attacks (TIAs). Compared with the use of phenoprocoumon, the use of DOAC was significantly associated with a lower thrombo-embolic risk [16 (1.2%) vs. 21 (2.2%), odds ratio (OR)], 0.5 [95% confidence interval (CI) 0.2-0.9], <i>P</i> = 0.04. No statistically significant association with bleeding risk was observed [phenprocomoun: 122 (13%); DOAC: 163 (12.6%); OR 0.9 (95% CI 0.7-1.2); <i>P</i> = 0.70]. Interruption of oral anticoagulation (OAC) was associated with an increased risk for thrombo-embolic complications [OR 2.2 (1.1-4.3); <i>P</i> = 0.031], and bleeding [OR 2.5 (95% CI 1.8-3.2), <i>P</i> = 0.001].</p><p><strong>Conclusion: </strong>In patients undergoing catheter ablation for AF, the use of DOAC was associated with a reduced risk of thrombo-embolic events compared with phenprocoumon. Non-interrupted oral anticoagulation (OAC) therapy was associated with a reduced risk of peri-procedural thrombo-embolic and any bleeding complications.</p>","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 4","pages":"oead065"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/89/oead065.PMC10329261.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is electrical neuromodulation able to affect the extent and stability of coronary atheromatous plaques?","authors":"John E Sanderson, Michael J L DeJongste","doi":"10.1093/ehjopen/oead063","DOIUrl":"10.1093/ehjopen/oead063","url":null,"abstract":"","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 4","pages":"oead063"},"PeriodicalIF":0.0,"publicationDate":"2023-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4f/4d/oead063.PMC10317289.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10180888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of population screening for cardiovascular disease on quality of life.","authors":"Rikke Søgaard, Axel Diederichsen, Jes Lindholt","doi":"10.1093/ehjopen/oead055","DOIUrl":"10.1093/ehjopen/oead055","url":null,"abstract":"<p><strong>Aims: </strong>To examine the impact of population screening-generated events on quality of life: invitation, positive test result, initiation of preventive medication, enrolment in follow-up at the surgical department, and preventive surgical repair.</p><p><strong>Methods and results: </strong>A difference-in-difference design based on data collected alongside two randomized controlled trials where general population men were randomized to screening for cardiovascular disease or to no screening. Repeated measurements of health-related quality of life (HRQoL) were conducted up to 3 years after inclusion using all relevant scales of the EuroQol instrument: the anxiety/depression dimension, the EuroQol 5-dimension profile index (using Danish preference weights), and the visual analogue scale for global health. We compare the mean change scores from before to after events for groups experiencing vs. not experiencing the events. Propensity score matching is additionally used to provide both unmatched and matched results. Invitees reported to be marginally better off than non-invitees on all scales of the EuroQol. For events of receiving the test result, initiating preventive medication, being enrolled in surveillance, and undergoing surgical repair, we observed no impact on overall HRQoL but a minor impact of being enrolled in surveillance on emotional distress, which did not persist after matching.</p><p><strong>Conclusion: </strong>The often-claimed detrimental consequences of screening to HRQoL could not be generally confirmed. Amongst the screening events assessed, only two possible consequences were revealed: a reassurance effect after a negative screening test and a minor negative impact to emotional distress of being enrolled in surveillance that did not spill over to overall HRQoL.</p>","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 3","pages":"oead055"},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/6a/oead055.PMC10246813.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9663294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study.","authors":"Elizabeth A Ellins,&nbsp;Kathie Wareham,&nbsp;Daniel E Harris,&nbsp;Matthew Hanney,&nbsp;Ashley Akbari,&nbsp;Mark Gilmore,&nbsp;James P Barry,&nbsp;Ceri J Phillips,&nbsp;Michael B Gravenor,&nbsp;Julian P Halcox","doi":"10.1093/ehjopen/oead047","DOIUrl":"https://doi.org/10.1093/ehjopen/oead047","url":null,"abstract":"<p><strong>Aims: </strong>Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of systematic electrocardiogram (ECG) screening on cardiovascular outcomes is unclear.</p><p><strong>Methods and results: </strong>In the original REHEARSE-AF study, patients were randomized to twice-weekly portable electrocardiogram (iECG) assessment or routine care. After discontinuing the trial portable iECG assessment, electronic health record data sources provided longer-term follow-up analysis. Cox regression was used to provide unadjusted and adjusted hazard ratios (HR) [95% confidence intervals (CI)] for clinical diagnosis, events, and anticoagulant prescriptions during the follow-up period. Over the median 4.2-year follow-up, although a greater number of patients were diagnosed with AF in the original iECG group (43 vs. 31), this was not significant (HR 1.37, 95% CI 0.86-2.19). No differences were seen in the number of strokes/systemic embolisms or deaths between the two groups (HR 0.92, 95% CI 0.54-1.54; HR 1.07, 95% CI 0.66-1.73). Findings were similar when restricted to those with CHADS-VASc ≥ 4.</p><p><strong>Conclusion: </strong>A 1-year period of home-based, twice-weekly screening for AF increased diagnoses of AF for the screening period but did not lead to increased diagnoses of AF or a reduction in cardiovascular-related events or all-cause death over a median of 4.2 years, even in those at highest risk of AF. These results suggest that benefits of regular ECG screening over a 1-year period are not maintained after cessation of the screening protocol.</p>","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 3","pages":"oead047"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/34/oead047.PMC10187779.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9495964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of exercise electrocardiography versus exercise echocardiography in women presenting with suspected coronary artery disease: a randomized study.","authors":"Sothinathan Gurunathan,&nbsp;Mayooran Shanmuganathan,&nbsp;Ankur Chopra,&nbsp;Jiwan Pradhan,&nbsp;Lily Aboud,&nbsp;Reinette Hampson,&nbsp;Haci Yakup Yakupoglu,&nbsp;Gabriel Bioh,&nbsp;Ann Banfield,&nbsp;Heather Gage,&nbsp;Raj Khattar,&nbsp;Roxy Senior","doi":"10.1093/ehjopen/oead053","DOIUrl":"https://doi.org/10.1093/ehjopen/oead053","url":null,"abstract":"<p><strong>Aims: </strong>There is a paucity of randomized diagnostic studies in women with suspected coronary artery disease (CAD). This study sought to assess the relative value of exercise stress echocardiography (ESE) compared with exercise electrocardiography (Ex-ECG) in women with CAD.</p><p><strong>Methods and results: </strong>Accordingly, 416 women with no prior CAD and intermediate probability of CAD (mean pre-test probability 41%), were randomized to undergo either Ex-ECG or ESE. The primary endpoints were the positive predictive value (PPV) for the detection of significant CAD and downstream resource utilization. The PPV of ESE and Ex-ECG were 33% and 30% (<i>P</i> = 0.87), respectively for the detection of CAD. There were similar clinic visits (36 vs. 29, <i>P</i> = 0.44) and emergency visits with chest pain (28 vs. 25, <i>P</i> = 0.55) in the Ex-ECG and ESE arms, respectively. At 2.9 years, cardiac events were 6 Ex-ECG vs. 3 ESE, <i>P</i> = 0.31. Although initial diagnosis costs were higher for ESE, more women underwent further CAD testing in the Ex-ECG arm compared to the ESE arm (37 vs. 17, <i>P</i> = 0.003). Overall, there was higher downstream resource utilization (hospital attendances and investigations) in the Ex-ECG arm (<i>P</i> = 0.002). Using National Health Service tariffs 2020/21 (British pounds) the cumulative diagnostic costs were 7.4% lower for Ex-ECG compared with ESE, but this finding is sensitive to the cost differential between ESE and Ex-ECG.</p><p><strong>Conclusion: </strong>In intermediate-risk women who are able to exercise, Ex-ECG had similar efficacy to an ESE strategy, with higher resource utilization whilst providing cost savings.</p>","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 3","pages":"oead053"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/51/73/oead053.PMC10253116.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9618606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyssynchrony and resynchronization in heart failure-effects on regional and global gene expression in a murine pacemaker model.","authors":"Marcus Ståhlberg,&nbsp;Eric Rullman,&nbsp;John Pernow,&nbsp;Ryo Nakagawa,&nbsp;Hugo Nordin,&nbsp;Frieder Braunschweig,&nbsp;Karin Ljung","doi":"10.1093/ehjopen/oead058","DOIUrl":"https://doi.org/10.1093/ehjopen/oead058","url":null,"abstract":"Department of Medicine; Solna, Karolinska Institutet and ME Cardiology, Karolinska University Hospital, Norrbacka S1:02, Eugeniavagen 27, 171 77 Stockholm, Sweden; Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; and Endorsed Course in Pediatric Community Medicine, Nihon institute of Medical Science, Saitama, Japan","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 3","pages":"oead058"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/25/oead058.PMC10284334.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9712363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary artery calcium among patients with heterozygous familial hypercholesterolaemia.","authors":"Hayato Tada,&nbsp;Nobuko Kojima,&nbsp;Kan Yamagami,&nbsp;Akihiro Nomura,&nbsp;Atsushi Nohara,&nbsp;Soichiro Usui,&nbsp;Kenji Sakata,&nbsp;Kenshi Hayashi,&nbsp;Noboru Fujino,&nbsp;Masayuki Takamura,&nbsp;Masa-Aki Kawashiri","doi":"10.1093/ehjopen/oead046","DOIUrl":"https://doi.org/10.1093/ehjopen/oead046","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to determine if coronary artery calcium (CAC) is associated with cardiovascular disease (CVD) events, defined as CVD-related death, unstable angina, myocardial infarction, or staged revascularization among patients with heterozygous familial hypercholesterolaemia (HeFH) under primary prevention settings.</p><p><strong>Methods and results: </strong>Data of patients with FH admitted to Kanazawa University Hospital between 2000 and 2020, who underwent CAC measurement and were followed up (<i>n</i> = 622, male = 306, mean age = 54 years), were retrospectively reviewed. Risk factors for CVD events were determined using the Cox proportional hazard model. The median follow-up duration was 13.2 years (interquartile range: 9.8-18.4 years). We observed 132 CVD events during the follow-up period. The event rate per 1000 person-years for CAC scores of 0 [<i>n</i> = 283 (45.5%)], 1-100 [<i>n</i> = 260 (41.8%)], and >100 [<i>n</i> = 79 (12.7%)] was 1.2, 17.0, and 78.8, respectively. Log (CAC score + 1) was a significant predictor of the occurrence of CVD events (hazard ratio: 3.24; 95% confidence interval: 1.68-4.80; <i>P</i> < 0.0001) in the multivariate Cox regression analysis, independent of other factors. The risk discrimination of CVD events was enhanced by adding CAC information to other conventional risk factors (<i>C</i>-statistics: 0.833-0.934; <i>P</i> < 0.0001).</p><p><strong>Conclusion: </strong>The CAC score helps in further risk stratification in patients with HeFH.</p>","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 3","pages":"oead046"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10182732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9488234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel echocardiographic risk score for light-chain amyloidosis.","authors":"Paul Geenty,&nbsp;Shanthosh Sivapathan,&nbsp;Luke D Stefani,&nbsp;Matthew Zada,&nbsp;Anita Boyd,&nbsp;David Richards,&nbsp;Fiona Kwok,&nbsp;Liza Thomas","doi":"10.1093/ehjopen/oead040","DOIUrl":"https://doi.org/10.1093/ehjopen/oead040","url":null,"abstract":"<p><strong>Aims: </strong>The prognosis of light-chain (AL) amyloidosis, a plasma cell dyscrasia, is largely determined by the presence of cardiac involvement. Conventional staging is achieved using cardiac biomarkers (high-sensitivity troponin, <i>N</i>-terminal pro-beta natriuretic peptide) and free light-chain difference (Mayo staging). We sought to evaluate the role of echocardiographic parameters as prognostic markers in AL amyloidosis and examine their utility compared with conventional staging.</p><p><strong>Methods and results: </strong>Seventy-five consecutive patients with AL amyloidosis reviewed at a referral amyloid clinic who underwent comprehensive echocardiographic assessment were retrospectively identified. The evaluated echocardiographic parameters included left ventricular (LV) ejection fraction, mass, diastolic function parameters, global longitudinal strain (GLS), and left atrial (LA) volume. Mortality was assessed through a review of clinical records. During a median follow-up of 51 months, 29/75 (39%) patients died. Patients who died had a larger LA volume (47 ± 12 vs. 35 ± 10 mL/m², <i>P</i> < 0.001) and a higher <i>E</i>/<i>e</i>' (18 ± 10 vs. 14 ± 6, <i>P</i> = 0.026). Univariate clinical and echocardiographic predictors of survival included LA volume, <i>E</i>/<i>e</i>', <i>e</i>', LVGLS, and Mayo stage (at significance of <i>P</i> < 0.1). Left atrial volume and LVGLS were significant determinants of mortality when examined using clinical cut-offs, although <i>E</i>/<i>e</i>' was not. A composite echocardiographic risk score comprising LA volume and LVGLS provided similar prognostic performance to Mayo stage [area under the curve (AUC) 0.75, 95% confidence interval (CI) 0.64-0.85 vs. AUC 0.75, 95% CI 0.65-0.858, <i>P</i> = 0.91].</p><p><strong>Conclusion: </strong>Left atrial volume and LVGLS were independent predictors of mortality in AL amyloidosis. A composite echocardiographic score combining LA volume and LVGLS has similar prognostic power to Mayo stage for all-cause mortality.</p>","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":"3 3","pages":"oead040"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/e6/oead040.PMC10152390.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9420529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}