Clinical features and predictors of atrial fibrillation in patients with light‐chain or transthyretin cardiac amyloidosis
Abstract Aims The study aimed to investigate the prevalence, phenotypic characteristics, and predictors of atrial fibrillation (AF) in patients presenting with cardiac amyloidosis (CA) of light‐chain (AL) or transthyretin (ATTR) type. Methods and results Clinical, biochemical, and echocardiographic...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-06-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13851 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832540314136477696 |
|---|---|
| author | Maria Papathanasiou Aiste‐Monika Jakstaite Sara Oubari Johannes Siebermair Reza Wakili Julia Hoffmann Alexander Carpinteiro Tim Hagenacker Andreas Thimm Christoph Rischpler Lukas Kessler Tienush Rassaf Peter Luedike |
| author_facet | Maria Papathanasiou Aiste‐Monika Jakstaite Sara Oubari Johannes Siebermair Reza Wakili Julia Hoffmann Alexander Carpinteiro Tim Hagenacker Andreas Thimm Christoph Rischpler Lukas Kessler Tienush Rassaf Peter Luedike |
| author_sort | Maria Papathanasiou |
| collection | DOAJ |
| description | Abstract Aims The study aimed to investigate the prevalence, phenotypic characteristics, and predictors of atrial fibrillation (AF) in patients presenting with cardiac amyloidosis (CA) of light‐chain (AL) or transthyretin (ATTR) type. Methods and results Clinical, biochemical, and echocardiographic data of patients presenting with CA between 2005 and 2020 were retrospectively collected. CA staging was based on established biomarker systems. Binomial logistic regression was run to analyse the effects of clinical variables on the likelihood of AF. The study included 133 patients [53% AL, 41% wild‐type (wt) ATTR‐CA, & 6% hereditary ATTR‐CA]. Mean age was 71 years, and 80% were male patients. AF was diagnosed in 64 (48%) patients (28% in AL‐CA, 80% in wtATTR, 13% in hATTR, P < 0.001). Patients with AF were older (74 vs. 69 years, P < 0.001), more likely to have wtATTR‐CA (67 vs. 16%, P < 0.001), exhibited more often New York Heart Association ≥ III symptoms (66 vs. 45%, P = 0.02) and carried a higher burden of comorbidities. AF patients had lower left ventricular ejection fraction (47 vs. 53%, P < 0.005), higher left atrial volume index (54 vs. 46 mL/m2, P = 0.007), higher pulmonary artery pressure (42 vs. 31 mmHg, P = 0.008), and worse tricuspid annular plane systolic excursion values (17 vs. 20 mm, P = 0.01). Mitral regurgitation ≥ Grade 2 was more frequent in AF (56 vs. 25%, P < 0.001). Higher ATTR‐CA stage was associated with higher AF prevalence (47% vs. 74% vs. 94%, P < 0.001, for Stages I, II, & III, respectively). Higher AL‐CA stage was associated with lower AF prevalence (0% vs. 40% vs. 31% vs. 18%, P < 0.001, for Stages I, II, IIIa, & IIIb, respectively). Three independent predictors for AF were identified in a multivariate logistic regression model with 81.5% classification accuracy: AL type [odds ratio (OR) 0.1, confidence interval (CI) 0.01–0.29, P = 0.001], estimated glomerular filtration rate (OR 0.9, CI 0.93–0.99, P = 0.03), and body mass index (OR 1.3, CI 1.07–1.66, P = 0.01). ATTR amyloidosis was associated with a 10‐fold higher risk of AF. During 1 year follow‐up, only one episode of ischaemic stroke was reported. Conclusions Atrial fibrillation affects nearly half of all patients with CA. Patients presenting with AF have more severe symptoms and higher burden of comorbidities. ATTR type of amyloidosis is the strongest predictor of AF. Prospective screening for occult AF may be considered in ATTR‐CA. |
| format | Article |
| id | doaj-art-3d3e725effb24187aa9436aa58c558c6 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-3d3e725effb24187aa9436aa58c558c62025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931740174810.1002/ehf2.13851Clinical features and predictors of atrial fibrillation in patients with light‐chain or transthyretin cardiac amyloidosisMaria Papathanasiou0Aiste‐Monika Jakstaite1Sara Oubari2Johannes Siebermair3Reza Wakili4Julia Hoffmann5Alexander Carpinteiro6Tim Hagenacker7Andreas Thimm8Christoph Rischpler9Lukas Kessler10Tienush Rassaf11Peter Luedike12Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center University Hospital Essen Hufelandstrasse 55 Essen 45147 GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center University Hospital Essen Hufelandstrasse 55 Essen 45147 GermanyDepartment of Hematology and Stem Cell Transplantation University Hospital Essen Essen GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center University Hospital Essen Hufelandstrasse 55 Essen 45147 GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center University Hospital Essen Hufelandstrasse 55 Essen 45147 GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center University Hospital Essen Hufelandstrasse 55 Essen 45147 GermanyDepartment of Hematology and Stem Cell Transplantation University Hospital Essen Essen GermanyDepartment of Neurology and Center for Translational Neuro‐ and Behavioral Sciences University Hospital Essen Essen GermanyDepartment of Neurology and Center for Translational Neuro‐ and Behavioral Sciences University Hospital Essen Essen GermanyDepartment of Nuclear Medicine University Hospital Essen Essen GermanyDepartment of Nuclear Medicine University Hospital Essen Essen GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center University Hospital Essen Hufelandstrasse 55 Essen 45147 GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center University Hospital Essen Hufelandstrasse 55 Essen 45147 GermanyAbstract Aims The study aimed to investigate the prevalence, phenotypic characteristics, and predictors of atrial fibrillation (AF) in patients presenting with cardiac amyloidosis (CA) of light‐chain (AL) or transthyretin (ATTR) type. Methods and results Clinical, biochemical, and echocardiographic data of patients presenting with CA between 2005 and 2020 were retrospectively collected. CA staging was based on established biomarker systems. Binomial logistic regression was run to analyse the effects of clinical variables on the likelihood of AF. The study included 133 patients [53% AL, 41% wild‐type (wt) ATTR‐CA, & 6% hereditary ATTR‐CA]. Mean age was 71 years, and 80% were male patients. AF was diagnosed in 64 (48%) patients (28% in AL‐CA, 80% in wtATTR, 13% in hATTR, P < 0.001). Patients with AF were older (74 vs. 69 years, P < 0.001), more likely to have wtATTR‐CA (67 vs. 16%, P < 0.001), exhibited more often New York Heart Association ≥ III symptoms (66 vs. 45%, P = 0.02) and carried a higher burden of comorbidities. AF patients had lower left ventricular ejection fraction (47 vs. 53%, P < 0.005), higher left atrial volume index (54 vs. 46 mL/m2, P = 0.007), higher pulmonary artery pressure (42 vs. 31 mmHg, P = 0.008), and worse tricuspid annular plane systolic excursion values (17 vs. 20 mm, P = 0.01). Mitral regurgitation ≥ Grade 2 was more frequent in AF (56 vs. 25%, P < 0.001). Higher ATTR‐CA stage was associated with higher AF prevalence (47% vs. 74% vs. 94%, P < 0.001, for Stages I, II, & III, respectively). Higher AL‐CA stage was associated with lower AF prevalence (0% vs. 40% vs. 31% vs. 18%, P < 0.001, for Stages I, II, IIIa, & IIIb, respectively). Three independent predictors for AF were identified in a multivariate logistic regression model with 81.5% classification accuracy: AL type [odds ratio (OR) 0.1, confidence interval (CI) 0.01–0.29, P = 0.001], estimated glomerular filtration rate (OR 0.9, CI 0.93–0.99, P = 0.03), and body mass index (OR 1.3, CI 1.07–1.66, P = 0.01). ATTR amyloidosis was associated with a 10‐fold higher risk of AF. During 1 year follow‐up, only one episode of ischaemic stroke was reported. Conclusions Atrial fibrillation affects nearly half of all patients with CA. Patients presenting with AF have more severe symptoms and higher burden of comorbidities. ATTR type of amyloidosis is the strongest predictor of AF. Prospective screening for occult AF may be considered in ATTR‐CA.https://doi.org/10.1002/ehf2.13851Atrial fibrillationAmyloidosisTransthyretinLight‐chainCardiomyopathy |
| spellingShingle | Maria Papathanasiou Aiste‐Monika Jakstaite Sara Oubari Johannes Siebermair Reza Wakili Julia Hoffmann Alexander Carpinteiro Tim Hagenacker Andreas Thimm Christoph Rischpler Lukas Kessler Tienush Rassaf Peter Luedike Clinical features and predictors of atrial fibrillation in patients with light‐chain or transthyretin cardiac amyloidosis ESC Heart Failure Atrial fibrillation Amyloidosis Transthyretin Light‐chain Cardiomyopathy |
| title | Clinical features and predictors of atrial fibrillation in patients with light‐chain or transthyretin cardiac amyloidosis |
| title_full | Clinical features and predictors of atrial fibrillation in patients with light‐chain or transthyretin cardiac amyloidosis |
| title_fullStr | Clinical features and predictors of atrial fibrillation in patients with light‐chain or transthyretin cardiac amyloidosis |
| title_full_unstemmed | Clinical features and predictors of atrial fibrillation in patients with light‐chain or transthyretin cardiac amyloidosis |
| title_short | Clinical features and predictors of atrial fibrillation in patients with light‐chain or transthyretin cardiac amyloidosis |
| title_sort | clinical features and predictors of atrial fibrillation in patients with light chain or transthyretin cardiac amyloidosis |
| topic | Atrial fibrillation Amyloidosis Transthyretin Light‐chain Cardiomyopathy |
| url | https://doi.org/10.1002/ehf2.13851 |
| work_keys_str_mv | AT mariapapathanasiou clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT aistemonikajakstaite clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT saraoubari clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT johannessiebermair clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT rezawakili clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT juliahoffmann clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT alexandercarpinteiro clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT timhagenacker clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT andreasthimm clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT christophrischpler clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT lukaskessler clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT tienushrassaf clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis AT peterluedike clinicalfeaturesandpredictorsofatrialfibrillationinpatientswithlightchainortransthyretincardiacamyloidosis |