Heart failure & cardiomyopathies
Stratifying Disease Progression in Patients With Cardiac ATTR Amyloidosis
Authors' conclusion
NT-proBNP progression and ODI are frequent and consistently associated with an increased risk of mortality.
Study context
- Population
- Patients with transthyretin cardiac amyloidosis (ATTR-CA)National Amyloidosis Centre (NAC) n = 1,598
- Participants
- 2,275 patients
- Exposure
- NT-proBNP progression and/or outpatient diuretic intensification (ODI) vs stable NT-proBNP and stable diuretic dose
- Outcome
- Mortality after the 1-year landmark by NT-proBNP progression and ODI
- Follow-up
- Between diagnosis and 1-year visit (landmark)
Methodological detailsmulticentre (7 specialist centers), landmark survival analysis, derivation and external validation cohorts
- Multicentre (7 specialist centers)
- Landmark survival analysis
- Derivation and external validation cohorts
Main finding
As reported in the abstract
Mortality
Each group vs stableHazard ratio (95% CI)P value
NT-proBNP progression or ODINAC cohort
1.93(1.65–2.27)
P < 0.001NT-proBNP progression or ODIvalidation cohort
1.94(1.36–2.77)
P < 0.001NT-proBNP progression and ODINAC cohort
2.98(2.42–3.67)
P < 0.001NT-proBNP progression and ODIvalidation cohort
3.23(2.17–4.79)
P < 0.001Observational data: associations, not effects.
Further findings
NT-proBNP progression (increase >700 ng/L and >30%) and mortality · between baseline and 1-year visits
| HR (95% CI) | P value | ||
|---|---|---|---|
| NT-proBNP progressionNAC cohort | 1.82 (1.57–2.10) | P < 0.001 | |
| NT-proBNP progressionValidation cohort | 1.75 (1.32–2.33) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
ODI and mortality · 1 year
| HR (95% CI) | P value | ||
|---|---|---|---|
| ODINAC cohort | 1.88 (1.62–2.18) | P < 0.001 | |
| ODIValidation cohort | 2.05 (1.53–2.74) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
- NT-proBNP progression (increase >700 ng/L and >30%) and mortality — NT-proBNP progression, NAC cohort
- 551 (34.5%)
- NT-proBNP progression (increase >700 ng/L and >30%) and mortality — NT-proBNP progression, validation cohort
- 204 (30.1%)
- ODI and mortality — ODI, NAC cohort
- 451 (28.2%)
- ODI and mortality — ODI, validation cohort
- 301 (44.5%)
Original publication
Stratifying Disease Progression in Patients With Cardiac ATTR Amyloidosis. J Am Coll Cardiol. Published 1 March 2024. doi:10.
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