Impact of tricuspid regurgitation on survival in patients with cardiac amyloidosis

Jerome Fagot; Yoan Lavie-Badie; Virginie Blanchard; Pauline Fournier; Michel Galinier; Didier Carrié; Olivier Lairez; Eve Cariou; Toulouse Amyloidosis Research Network collaborators

doi:10.1002/ehf2.13093

Impact of tricuspid regurgitation on survival in patients with cardiac amyloidosis

ESC Heart Fail. 2021 Feb;8(1):438-446. doi: 10.1002/ehf2.13093. Epub 2020 Dec 2.

Authors

Jerome Fagot^{1

2}, Yoan Lavie-Badie^{1

2

3}, Virginie Blanchard^{1

2

3

4}, Pauline Fournier^{1

2}, Michel Galinier^{1

2

4}, Didier Carrié^{1

2

4}, Olivier Lairez^{1

2

3

4}, Eve Cariou^{1

2}; Toulouse Amyloidosis Research Network collaborators

Collaborators

Toulouse Amyloidosis Research Network collaborators:
Laurent Alric, Christophe Bureau, Dominique Chauveau, Pascal Cintas, Magali Colombat, Audrey Delas, Delphine Dupin-Deguine, Stanislas Faguer, Antoine Huart, Bénédicte Puissant, Grégory Pugnet, Grégoire Prévot, David Ribes, Murielle Roussel, Laurent Sailler

Affiliations

¹ Department of Cardiology, Rangueil University Hospital, 1, avenue Jean Poulhès, TSA 50032, Toulouse Cedex 9, 31059, France.
² Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.
³ Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.
⁴ Medical School, Toulouse III Paul Sabatier University, Toulouse, France.

Abstract

Aims: Tricuspid regurgitation (TR) is a common finding and has been associated with poorer outcome in patients with heart failure. This study sought to investigate the prognostic value of TR in patients with cardiac amyloidosis (CA).

Methods and results: Two-hundred and eighty-three patients with CA-172 (61%) wild-type transthyretin amyloidosis (ATTRwt) and 111 (39%) light-chain amyloidosis (AL)-were consecutively enrolled between December 2010 and September 2019. Transthoracic echocardiographies at time of diagnosis were reviewed to establish the presence and severity of TR and its relationship with all-cause mortality during patients' follow-up. Seventy-four (26%) patients had a moderate-to-severe TR. Moderate-to-severe TR was associated with New York Heart Association status (P < 0.001), atrial fibrillation (P = 0.003), greater levels of natriuretic peptides (P = 0.002), worst renal function (P = 0.03), lower left ventricular ejection fraction (P = 0.02), reduced right ventricular systolic function (P = 0.001), thicker tricuspid leaflets (P = 0.019), greater tricuspid annulus diameter (P = 0.001), greater pulmonary artery pressure (P = 0.001), greater doses of furosemide (P = 0.001), and anti-aldosterone (P = 0.01) and more anticoagulant treatment (P = 0.001). One hundred and thirty-four (47%) patients met the primary endpoint of all-cause mortality. After multivariate Cox analysis, moderate-to-severe TR was significantly associated with mortality [hazard ratio 1.89, 95% confidence interval (1.01-3.51), P = 0.044] in patients with ATTRwt. There was no correlation between TR and death [hazard ratio 0.84, 95% confidence interval (0.46-1.51), P = 0.562] in patients with AL.

Conclusions: Moderate-to-severe TR is frequent in CA, and it is an independent prognosis factor in patients with ATTRwt but not in patients with AL.

Keywords: Cardiac amyloidosis; Light‐chain amyloidosis; Prognosis; Transthyretin amyloidosis; Tricuspid regurgitation.

MeSH terms

Amyloid Neuropathies, Familial*
Echocardiography
Humans
Stroke Volume
Tricuspid Valve Insufficiency*
Ventricular Function, Left