Gabriela Neculae, Amira Zaroui, Robert Adam, Mounira Kharoubi, Benoit Funalot, Daniel Coriu, Ruxandra Jurcut, Thibaud Damy
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Stage III was defined as GLS ≥ -11% and either one or both NT-proBNP and eGFR criteria, while the remaining patients were defined as Stage II. Stage I patients had a 98.5% (95% CI 94.8-100) 5-year survival rate, Stage II patients 75.1% (95% CI 64.8-87.1) and Stage III patients a 29.4% (95% CI 18.6-46.5) 5-year survival rate (Stage I vs. Stage II, P = 0.001; Stage II vs. Stage III, P < 0.001). After age is adjusted for, compared to Stage I, the hazard ratio (HR) for death was 9.9 (95% CI 1.28-76.27, P = 0.02) for Stage II and 39.75 (95% CI 5.28-299.54, P < 0.001) for Stage III patients. HRs and statistical significance were maintained across different ATTR genotypes. The staging system was validated in a cohort of 138 patients.</p><p><strong>Conclusions: </strong>We propose a novel staging system for ATTRv patients on specific treatment, based on two biological markers and one echocardiographic parameter, common in clinical practice.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A new staging system for hereditary transthyretin amyloidosis in the era of specific amyloidosis therapies.\",\"authors\":\"Gabriela Neculae, Amira Zaroui, Robert Adam, Mounira Kharoubi, Benoit Funalot, Daniel Coriu, Ruxandra Jurcut, Thibaud Damy\",\"doi\":\"10.1002/ehf2.15414\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Currently, there are two prognosis staging systems validated for transthyretin amyloidosis (ATTR). 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引用次数: 0
摘要
目的:目前,有两种经验证的甲状腺转维蛋白淀粉样变性(ATTR)预后分期系统。我们试图开发一种新的分期系统,专门用于遗传性甲状腺转蛋白淀粉样变性(ATTRv)患者的特异性治疗。方法和结果:来自法国和罗马尼亚两个心脏淀粉样变性参考中心的258例诊断为ATTRv的患者根据NT-proBNP、估计肾小球滤过率(eGFR)和全局纵向应变(GLS)将其分为三个疾病阶段。根据以下标准建立分期系统:GLS≥-11%,NT-proBNP≥2000 ng/L, eGFR≤65 mL/min。第一阶段被定义为不存在任何标准。III期定义为GLS≥-11%,NT-proBNP和eGFR标准中的一项或两项均为III期,其余患者定义为II期。I期患者的5年生存率为98.5% (95% CI 94.8-100), II期患者的5年生存率为75.1% (95% CI 64.8-87.1), III期患者的5年生存率为29.4% (95% CI 18.6-46.5) (I期vs II期,P = 0.001; II期vs III期,P)结论:基于临床实践中常见的两种生物标志物和一种超声心动图参数,我们为接受特异性治疗的ATTRv患者提出了一种新的分期系统。
A new staging system for hereditary transthyretin amyloidosis in the era of specific amyloidosis therapies.
Objectives: Currently, there are two prognosis staging systems validated for transthyretin amyloidosis (ATTR). We sought to develop a new staging system dedicated to hereditary transthyretin amyloidosis (ATTRv) patients on specific treatments.
Methods and results: A total of 258 patients diagnosed with ATTRv from two cardiac amyloidosis reference centres in France and Romania were stratified into three disease stages based on NT-proBNP, estimated glomerular filtration rate (eGFR) and global longitudinal strain (GLS). A staging system was created using the following criteria: GLS ≥ -11%, NT-proBNP ≥ 2000 ng/L and eGFR ≤ 65 mL/min. Stage I was defined as the presence of none of the criteria. Stage III was defined as GLS ≥ -11% and either one or both NT-proBNP and eGFR criteria, while the remaining patients were defined as Stage II. Stage I patients had a 98.5% (95% CI 94.8-100) 5-year survival rate, Stage II patients 75.1% (95% CI 64.8-87.1) and Stage III patients a 29.4% (95% CI 18.6-46.5) 5-year survival rate (Stage I vs. Stage II, P = 0.001; Stage II vs. Stage III, P < 0.001). After age is adjusted for, compared to Stage I, the hazard ratio (HR) for death was 9.9 (95% CI 1.28-76.27, P = 0.02) for Stage II and 39.75 (95% CI 5.28-299.54, P < 0.001) for Stage III patients. HRs and statistical significance were maintained across different ATTR genotypes. The staging system was validated in a cohort of 138 patients.
Conclusions: We propose a novel staging system for ATTRv patients on specific treatment, based on two biological markers and one echocardiographic parameter, common in clinical practice.
期刊介绍:
ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.