Heart failure & cardiomyopathies
Left ventricular myocardial work improves in response to treatment and is associated with survival among patients with light chain cardiac amyloidosis
Authors' conclusion
Complete haematologic response to treatment is associated with improved left ventricular myocardial work indices, and their change is associated with improved survival in AL-CA.
Study context
- Population
- Patients treated for light chain cardiac amyloidosis (AL-CA), echocardiography at baseline and 1 year
- Participants
- 61 patients
- Exposure
- Complete vs not complete haematologic response to treatment
- Outcome
- Change in echocardiographic indices of myocardial deformation and work (GLS, GWI) with response to treatment, and their prognostic significance
- Follow-up
- 1 year
Main finding
As reported in the abstract
Change in LV myocardial indices by haematologic response
- Complete response (CR) vs non-CR: more pronounced decrease in intraventricular septum thickness (CR 14.2-12.0 mm)
- P = 0.006
- CR vs non-CR: improved global longitudinal strain (GLS) (CR −11.6 to −13.1%)
- P for interaction = 0.045
- CR vs non-CR: increased global constructive work (CR 1245-1436 mmHg%)
- P = 0.008
- CR vs non-CR: increased global work index (GWI) (CR 926-1250 mmHg%)
- P = 0.002
Observational data: associations, not effects.
Further findings
Independent predictors of survival (adjusted for Mayo stage, gender, response status)
| HR | P value | |
|---|---|---|
| deltaGLS (per 1% increase) | 1.404 | P = 0.046 |
| deltaGWI (per 1mmHg% increase) | 0.996 | P = 0.042 |
Whole cohort changes, baseline to 1 year
- Median N-terminal pro-brain natriuretic peptide (NT-proBNP) reduced (2771-1486 pg/mL)
- P < 0.001
- Posterior wall thickness reduced (13-12 mm)
- P = 0.002
- GWI increased (1115-1356 mmHg%)
- P = 0.018
Correlation with delta NT-proBNP
- deltaGLS ρspearman = 0.35
- P < 0.001
- deltaGWI ρspearman = −0.32
- P = 0.02
Survival by GLS and GWI response
- Better prognosis with GLS response
- log-rank P = 0.048
- Better prognosis with GWI response
- log-rank P = 0.007
Original publication
Left ventricular myocardial work improves in response to treatment and is associated with survival among patients with light chain cardiac amyloidosis. Eur Heart J Cardiovasc Imaging. Published 24 December 2023. doi:10.
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