Beta-Adrenergic Antagonist Tolerance in Amyloid Cardiomyopathy

Stuart Ramsell; Carlos Arias Bermudez; Cyril Ayuk Mbeng Takem Baiyee; Brandon Rodgers; Samir Parikh; Salem Almaani; Nidhi Sharma; Samantha LoRusso; Miriam Freimer; Elyse Redder; Naresh Bumma; Ajay Vallkati; Yvonne Efebera; Rami Kahwash; Courtney M Campbell

doi:10.3389/fcvm.2022.907597

Beta-Adrenergic Antagonist Tolerance in Amyloid Cardiomyopathy

Front Cardiovasc Med. 2022 Jul 11:9:907597. doi: 10.3389/fcvm.2022.907597. eCollection 2022.

Authors

Affiliations

¹ College of Medicine, The Ohio State University, Columbus, OH, United States.
² Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
³ Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
⁴ Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
⁵ Department of Oncology Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
⁶ Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
⁷ Division of Hematology/Oncology, OhioHealth, Columbus, OH, United States.
⁸ Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, United States.

Abstract

Background: Beta-adrenergic antagonists or blockers (BB) are a cornerstone of cardiac therapy for multiple indications. However, BB are considered relatively contraindicated in amyloid cardiomyopathy due to poor tolerance. This intolerance is hypothesized to be due to concomitant neuropathy and significant restrictive cardiomyopathy. This study analyzes the incidence and characteristics of BB tolerance in patients with amyloid cardiomyopathy.

Methods: Through a single-center retrospective chart review, patients with amyloid cardiomyopathy, confirmed by endomyocardial biopsy or technetium-99 pyrophosphate scan, were identified and clinical data was collected. Statistical methods included Chi-square test and two sample t-tests.

Results: Of 135 cardiac amyloidosis patients, 27 patients (20.0%) had no BB use, 56 patients (41.5%) were current BB users, and 52 patients (38.5%) were prior BB users. The most frequent indications for BB use were heart failure, hypertension, coronary artery disease, and arrhythmia. The most common reason for stopping BB therapy was hypotension (62.8%) followed by fatigue, bradycardia, and orthostasis. Neurologic symptoms at the initial BB prescription or most recent evaluation were not significantly different between current and prior BB users. Their cardiovascular profiles were similar by ejection fraction, wall thickness, troponin I, and brain natriuretic peptide. There was no association for BB discontinuation based on amyloid subtype, sex, or race.

Conclusion: The majority of patients with amyloid cardiomyopathy were prescribed BB, and over half of these patients still tolerated BB therapy. Current and prior BB users had similar profiles from a cardiovascular and neurologic perspective, with no association identified to predict BB discontinuation.

Keywords: amyloidosis; heart failure; light chain; pharmacology; transthyretin.