Heart failure & cardiomyopathies
A New Staging System Using Right Atrial Strain in Patients with Immunoglobulin Light-Chain Cardiac Amyloidosis
Authors' conclusion
The new staging system using RASr and BNP predicted prognosis in patients with AL cardiac amyloidosis.
Study context
- Population
- Patients with AL cardiac amyloidosis, Kumamoto University Hospital, 2007–2022of 78 diagnosed
- Participants
- 72 patients
- Exposure
- All-cause death vs survival; staging score
- All-cause deathn = 31
- Outcome
- All-cause death
- Follow-up
- Median 403 days
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
All-cause death by staging score (RASr <16.4% or BNP >311.2 pg/mL, 1 point each)
Hazard ratio (95% CI)P value
Score 1 vs Score 0
5.95(1.19–29.79)
P < 0.05Score 2 vs Score 0
23.29(5.37–100.98)
P < 0.01Observational data: associations, not effects.
Further findings
RASr and all-cause death, adjusted for right ventricular GLS (RV-GLS), LV-GLS and LASr
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| RASr | 0.91 (0.83–0.99) | P < 0.05 | |
| 0.512Hazard ratio (log scale) |
RASr and log BNP and all-cause death, adjusted for log troponin T and estimated glomerular filtration rate (eGFR)
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| RASr | 0.93 (0.87–1.00) | P < 0.05 | |
| Log BNP | 2.10 (1.17–3.79) | P < 0.05 | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | All-cause death | Survival |
|---|---|---|
| Strain measures | ||
| LV-GLS | 8.5 ± 4.3% | 11.8 ± 3.8% |
| LASr | 8.8 ± 7.1% | 14.3 ± 8.1% |
| RV-GLS | 11.6 ± 5.1% | 16.4 ± 3.9% |
| RASr | 10.2 ± 7.3% | 20.7 ± 9.5% |
| eGFR, BNP, hs-cTnT | ||
| eGFR | 48.2 ± 21.0 mL/min/1.73 m² | 59.4 ± 24.4 mL/min/1.73 m² |
| BNP | 725 [360-1312] pg/mL | 123 [81-310] pg/mL |
| hs-cTnT | 0.12 [0.07-0.18] ng/mL | 0.05 [0.03-0.08] ng/mL |
- ROC cut-offs for all-cause mortality — Low RASr (<16.4%) or high BNP (>311.2 pg/mL): significantly higher probability of all-cause death (Kaplan-Meier)
- P < 0.01
- ROC cut-offs for all-cause mortality: RASr 16.4% sensitivity 66% · specificity 84% · AUC 0.81
- ROC cut-offs for all-cause mortality: BNP 311.2 pg/mL sensitivity 83% · specificity 78% · AUC 0.82
- Strain measures: all P < 0.01
- eGFR, BNP, high sensitivity cardiac troponin T (hs-cTnT): eGFR P < 0.05; BNP P < 0.01; hs-cTnT P < 0.01
Original publication
A New Staging System Using Right Atrial Strain in Patients with Immunoglobulin Light-Chain Cardiac Amyloidosis. ESC Heart Fail. Published 23 February 2024. doi:10.
Summarised from the published abstract; every number is checked against it