Phenotype and prognostic factors in geriatric and non-geriatric patients with transthyretin cardiomyopathy

被引:0
作者
Volpentesta, Eugenia [1 ,2 ]
Kharoubi, Mounira [3 ,4 ,5 ,6 ]
Donadio, Cristiano [2 ]
Rebiai, Kahina [3 ,4 ]
Fanen, Pascale [7 ]
Funalot, Benoit [5 ,7 ]
Gendre, Thierry [8 ,9 ]
Audard, Vincent [9 ,10 ]
Canoui-Poitrine, Florence [6 ,11 ,12 ]
Itti, Emmanuel [9 ,13 ,14 ]
Teiger, Emmanuel [3 ,4 ,5 ,6 ]
Plante-Bordeneuve, Violaine [8 ,9 ]
Oghina, Silvia [3 ,4 ]
Tixier, Denis [3 ,4 ]
Mallet, Sophie [3 ,4 ]
Broussier, Amaury [11 ,15 ]
Damy, Thibaud [3 ,4 ,5 ,6 ,11 ,15 ]
Zaroui, Amira [3 ,4 ,5 ,6 ,11 ]
机构
[1] Henri Mondor Albert Chenevier Hosp, AP HP Assistance Publ Hop Paris, Dept Geriatr, Creteil, France
[2] Charles Foix Hosp, AP HP Assistance Publ Hop Paris, Dept Geriatr, Ivry, France
[3] Henri Mondor Univ Hosp, AP HP Assistance Publ Hop Paris, Dept Cardiol, DMU Care, Creteil, France
[4] Henri Mondor Univ Hosp, AP HP Assistance Publ Hop Paris, Cardiogen Network, Cardiac Amyloidosis Referral Ctr, Creteil, France
[5] Henri Mondor Univ Hosp, AP HP Assistance Publ Hop Paris, GRC Amyloid Res Inst, Creteil, France
[6] Henri Mondor Univ Hosp, AP HP Assistance Publ Hop Paris, DHU A TVB, Creteil, France
[7] Henri Mondor Univ Hosp, AP HP Assistance Publ Hop Paris, Dept Genet, Creteil, France
[8] Henri Mondor Univ Hosp, AP HP Assistance Publ Hop Paris, Dept Neurol, Creteil, France
[9] Univ Paris Est Creteil, Inst Natl Sante & Rech Med INSERM U955, Inst Mondor Rech Biomed IMRB, Creteil, France
[10] Henri Mondor Hosp, AP HP Assistance Publ Hop Paris, Dept Nephrol & Renal Transplantat, Creteil, France
[11] Clin Epidemiol & Ageing CEpiA Geriatr Primary Care, Creteil, France
[12] Henri Mondor Univ Hosp, AP HP Assistance Publ Hop Paris, Dept Publ Hlth Dept, Creteil, France
[13] Henri Mondor Univ Hosp, AP HP Assistance Publ Hop Paris, Dept Nucl Med, Creteil, France
[14] Henri Mondor Univ Hosp, AP HP Assistance Publ Hop Paris, Clin Invest Ctr 1430, Creteil, France
[15] Hop Henri Mondor Emile Roux, AP HP, Dept Geriatr, F-94456 Limeil Brevannes, France
来源
ESC HEART FAILURE | 2024年
关键词
ATTR-CM; Genetic testing; Geriatric; Observational; Prognostic factors; CARDIAC AMYLOIDOSIS; NATURAL-HISTORY; DISEASE; HEREDITARY; EFFICACY; SAFETY;
D O I
10.1002/ehf2.14793
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Transthyretin cardiac amyloidosis (ATTR-CM) may be an underestimated cause of heart failure among geriatric patients and represent a unique phenotype and prognostic profile. Methods and results This retrospective, observational, cohort study characterizes cardiac and extracardiac disorders at diagnosis and assesses prognosis among ATTR-CM patients based on age (geriatric vs. non-geriatric) and amyloidosis subtype (wild type, ATTRwt and hereditary, ATTRv). In total, 943 patients with ATTR-CM were included, of which 306 had ATTRv and 637 had ATTRwt. Among these, 331 (35.1%) were non-geriatric (<75 years), and 612 (64.9%) were geriatric (>= 75 years). The population exhibited conduction abnormalities, atrial fibrillation and ischaemic heart disease that progressively deteriorated with age. Among ATTRwt patients, peripheral neuropathy, neurovegetative symptoms, and hearing loss were present across all age groups, but reports of carpal tunnel symptoms or surgery decreased with age. Conversely, among ATTRv patients, reports of extracardiac symptoms increased with age and Val122ILe mutation was highly prevalent among geriatric patients. The 3-year survival was higher among non-geriatric ATTR-CM patients (76%) than geriatric patients (55%) and predictors of 3-year mortality differed. Notably, predictors identified among geriatric patients were alkaline phosphatase (ALP) (HR = 1.004, 95% CI: [0.001-1.100)], troponin T hs (HR = 1.005, 95% CI: [1.001-1.120)] and tricuspid insufficiency (HR = 1.194, 95% CI: [1.02-1.230)]. Whereas, among non-geriatric patients, NT-proBNP (HR = 1.002, 95% CI: [1.02-1.04], global longitudinal strain (HR = 0.95, 95% CI: [0.922-0.989], and glomerular filtration rate (HR = 0.984, 95% CI: [0.968-1.00) were identified. We propose a 3-stage prognostic staging system combining troponin T hs (>= 44 ng/L) and ALP levels (>= 119 UI/L). In the geriatric population, this model discriminated survival more precisely than the National Amyloidosis Centre staging, particularly for classifying between stage 1 (82%), stage 2 (50%) and stage 3 (32%) for ATTRv and ATTRwt. Conclusions These diagnostic and prognostic indicators, along with ATTR subtype, highlight the distinct characteristics of this important, geriatric ATTR-CM patient group. Recognizing these mortality markers can be valuable for geriatricians to improve the prognostic quality management of geriatric patients with ATTR-CM.
引用
收藏
页码:3814 / 3832
页数:19
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