Left ventricular myocardial work index and short-term prognosis in patients with light-chain cardiac amyloidosis: a retrospective cohort study

Jiaran Shi; Yakui Wu; Bifeng Wu; Dongxia Yu; Yanan Chu; Fangcong Yu; Deheng Han; Tianxin Ye; Xinran Tao; Jinxiu Yang; Xingxiang Wang

doi:10.21037/qims-22-386

Left ventricular myocardial work index and short-term prognosis in patients with light-chain cardiac amyloidosis: a retrospective cohort study

Quant Imaging Med Surg. 2023 Jan 1;13(1):133-144. doi: 10.21037/qims-22-386. Epub 2022 Oct 21.

Authors

Jiaran Shi^#¹, Yakui Wu^#¹, Bifeng Wu¹, Dongxia Yu^{1

2}, Yanan Chu¹, Fangcong Yu¹, Deheng Han¹, Tianxin Ye¹, Xinran Tao¹, Jinxiu Yang¹, Xingxiang Wang¹

Affiliations

¹ Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
² Department of Electrocardiogram, Zhejiang Qingchun Hospital, Hangzhou, China.

^# Contributed equally.

Abstract

Background: Reports show that the left ventricular myocardial work index (LVMWI) is a novel parameter for evaluating cardiac function. Decompensated heart failure leads to a high rate of early mortality in advanced patients with light-chain cardiac amyloidosis (AL-CA) and prevents them from a relatively delayed response to chemotherapy. This study aimed to assess the association of the LVMWI with short-term outcomes and to construct a simple model for risk stratification.

Methods: A total of 79 patients with an initial diagnosis of AL-CA were included in this retrospective cohort study. LVMWI was calculated by integrating brachial artery cuff blood pressure and left ventricular longitudinal strain (LVLS). The short-term outcome was defined as 6-month all-cause mortality. Receiver operating characteristic (ROC), logistic regression, and Kaplan-Meier analysis were used in this study.

Results: The median follow-up time was 21 months (3-36 months), and 23 (29%) patients died in the first 6 months. The time-dependent ROC and the area under the curve (AUC) showed that the LVMWI had the best predictive potential at the 6-month time point [AUC =0.805; 95% confidence interval (CI): 0.690-0.920]. A bivariate prognostic model based on the LVMWI was constructed, and D-dimer showed a synergistic effect with optimum predicted potential (AUC =0.877; 95% CI: 0.791-0.964). Kaplan-Meier analysis demonstrated that patients with two, one, and none of the variates beyond the cut-off value bore a different risk of 6-month all-cause mortality (accumulated mortality was 86%, 30%, 3%, respectively; log-rank, P<0.001). Multivariate nested logistic regression showed that the level of D-dimer provided an incremental prognostic value (Δχ²=10.3; P=0.001) to the value determined from New York Heart Association (NYHA) classification and the LVMWI.

Conclusions: The LVMWI is associated with the short-term outcome of patients with AL-CA. The D-dimer test provides additional prognostic information for the LVMWI.

Keywords: D-dimer; Light-chain cardiac amyloidosis (AL-CA); left ventricular myocardial work index (LVMWI); short-term outcome.