Biomarkers and Prediction of Prognosis in Transthyretin-Related Cardiac Amyloidosis: Direct Comparison of Two Staging Systems

被引：30

作者：

Cappelli, Francesco ^{[1
,2
]}

Martone, Raffaele ^{[1
]}

Gabriele, Martina ^{[1
]}

Taborchi, Giulia ^{[1
]}

Morini, Sofia ^{[1
]}

Vignini, Elisa ^{[1
]}

Allinovi, Marco ^{[1
]}

Di Gioia, Massimo ^{[1
]}

Bartolini, Simone ^{[1
,3
]}

Di Mario, Carlo ^{[2
]}

Perfetto, Federico ^{[1
]}

机构：

[1] Careggi Univ Hosp, Tuscan Reg Amyloidosis Ctr, Florence, Italy

[2] Careggi Univ Hosp, Cardiothoracovasc Dept, Div Intervent Struct Cardiol, Florence, Italy

[3] Azienda Sanit Firenze, Cardiol Dept, Florence, Italy

来源：

CANADIAN JOURNAL OF CARDIOLOGY | 2020年 / 36卷 / 03期

关键词：

BRAIN NATRIURETIC PEPTIDE; RENAL DYSFUNCTION; HEART-FAILURE; TROPONINS; DIAGNOSIS; SURVIVAL;

D O I：

10.1016/j.cjca.2019.12.020

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The severity of heart disease varies widely among patients with transthyretin-related cardiac amyloidosis (ATTR-CA) at presentation, and availability of tools able to predict prognosis is essential for clinical and research purposes. Currently, two biomarker-based staging systems are available. The aim of this study was to compare their predictive performance. Methods: A total of 175 patients diagnosed with ATTR-CA (133 wild-type and 42 hereditary) were stratified into different stages based on 2 systems: the first system included N-terminal pro-B-type natriuretic peptide (NT-proBNP) and estimated glomerular filtration rate (eGFR), and the second one included NT-proBNP and troponin I (TnI). Survival estimates and age-adjusted survival for all-cause mortality were analysed over a median follow-up of 27 months (interquartile range 16-43 months). Results: Predictive performance was more accurate when NT-proBNP and eGFR were used, resulting in effective survival stratification: 64.4 months for stage 1, 44.6 months for stage 2, and 20.5 months for stage 3 (P < 0.01 for stages 1 vs 2; P < 0.0001 for stages 1 vs 3; P < 0.0001 stages 2 vs 3). The combination of NT-proBNP and TnI was unable to effectively differentiate survival: 64.5 months for stage 1, 50.9 months for stage 2, and 27.3 months for stage 3 (P = 0.223 for stages 1 vs 2; P < 0.0001 for stages 1 vs 3; P < 0.0001 for stages 2 vs 3). The same results were seen after age adjustment. Conclusions: A staging system using NT-proBNP and eGFR had better prognostic accuracy for ATTR-CA patients compared with one using NTproBNP and TnI.

引用

页码：424 / 431

页数：8

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