Incremental Value of Global Longitudinal Strain for Predicting Survival in Patients With Advanced AL Amyloidosis

被引:41
作者
Chuy, Katherine Lee [1 ]
Drill, Esther [2 ]
Yang, Ji Can [3 ]
Landau, Heather [4 ,5 ]
Hassoun, Hani [5 ,6 ]
Nahhas, Omar [7 ]
Chen, Carol L. [5 ,7 ]
Yu, Anthony F. [5 ,7 ]
Steingart, Richard M. [5 ,7 ]
Liu, Jennifer E. [5 ,7 ]
机构
[1] Cook Cty Hlth, Dept Cardiol, Chicago, IL USA
[2] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10021 USA
[3] New York Presbyterian Brooklyn Methodist Hosp, New York, NY USA
[4] Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplant Serv, 1275 York Ave, New York, NY 10021 USA
[5] Weill Cornell Med Coll, Dept Med, 1275 York Ave, New York, NY 10065 USA
[6] Mem Sloan Kettering Canc Ctr, Dept Med, Myeloma Serv, 1275 York Ave, New York, NY 10021 USA
[7] Mem Sloan Kettering Canc Ctr, Dept Med, Cardiol Serv, 1275 York Ave, New York, NY 10021 USA
来源
JACC: CARDIOONCOLOGY | 2020年 / 2卷 / 02期
关键词
amyloidosis; cardiomyopathy; echocardiography; global longitudinal strain; prognosis; LIGHT-CHAIN AMYLOIDOSIS; BRAIN NATRIURETIC PEPTIDE; PRIMARY SYSTEMIC AMYLOIDOSIS; CARDIAC BIOMARKERS; STAGING SYSTEM; TROPONINS; DIAGNOSIS; MELPHALAN;
D O I
10.1016/j.jaccao.2020.05.012
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND Advanced light-chain (AL) amyloidosis is associated with poor prognosis, with a 5-year survival rate of <25%. Prognostication is based on the revised Mayo (rMayo) staging according to serum cardiac biomarkers. OBJECTIVES This study sought to determine whether global longitudinal strain (GLS) can provide incremental prognostic value in patients with advanced disease. METHODS Baseline (pre-treatment) clinical, 2-dimensional echocardiogram with GLS and laboratory data were collected prospectively in 94 patients with newly diagnosed AL amyloidosis with rMayo stage III or IV disease. Overall survival (OS) was defined as time from baseline echocardiography to death. RESULTS Of 94 patients, 60% (n = 56) had rMayo stage III and 40% (n = 38) had stage IV disease. Ninety of the 94 patients underwent plasma cell-directed therapy. The median left ventricular ejection fraction (LVEF) was 60%, and the median GLS was 13.2%. Of 94 patients, 64 died during follow-up. The median OS was 11.2 months, with an estimated 5-year OS of 21%. In univariable analysis, brain natriuretic peptides, GLS, LVEF, E/e' ratio, and rMayo stage were significantly associated with OS. In Cox regression, GLS provided incremental value over brain natriuretic peptide, troponin, and LVEF for predicting OS. Patients with GLS < -14.2% had a corresponding median OS and 5-year OS rate of 33.2 months and 39%, respectively, versus 7.7 months and 6% for those with GLS >= -14.2%. This difference was maintained despite further stratification by rMayo stage. CONCLUSIONS Baseline GLS is an independent predictor of OS beyond the circulating biomarkers and can identify groups with different survival outcomes beyond the Mayo Staging. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
引用
收藏
页码:223 / 231
页数:9
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