Document Detail

Independent predictors of survival in primary systemic (Al) amyloidosis, including cardiac biomarkers and left ventricular strain imaging: an observational cohort study.
MedLine Citation:
PMID:  20434879     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The prognostic value of Doppler myocardial imaging, including myocardial velocity imaging, strain, and strain rate imaging, in patients with primary (AL) amyloidosis is uncertain. The aim of this longitudinal study was to identify independent predictors of survival, comparing clinical data, hematologic and cardiac biomarkers, and standard echocardiographic and Doppler myocardial imaging measures in a cohort of patients with AL amyloidosis.
METHODS: A total of 249 consecutive patients with AL amyloidosis were prospectively enrolled. The primary end point was all-cause mortality, and during a median follow-up period of 18 months, 75 patients (30%) died. Clinical and electrocardiographic data, biomarkers (brain natriuretic peptide and cardiac troponin T) and standard echocardiographic and longitudinal systolic and diastolic Doppler myocardial imaging measurements for 16 left ventricular segments were tested as potential independent predictors of survival.
RESULTS: Age (hazard ratio [HR], 1.03; P = .03), New York Heart Association class III or IV (HR, 2.47; P = .01), the presence of pleural effusion (HR, 1.79; P = .08), brain natriuretic peptide level (HR, 1.29; P = .01), ejection time (HR, 0.99; P = .13), and peak longitudinal systolic strain of the basal anteroseptal segment (HR, 1.05; P = .02) were independent predictors in the final model.
CONCLUSIONS: Multivariate survival analysis identified independent predictors of clinical outcome in patients with AL amyloidosis: New York Heart Association class III or IV, presence of pleural effusion, brain natriuretic peptide level > 493 pg/mL, ejection time < 273 ms, and peak longitudinal systolic basal anteroseptal strain less negative than or equal to -7.5% defined a high-risk group of patients.
Diego Bellavia; Patricia A Pellikka; Ghormallah B Al-Zahrani; Theodore P Abraham; Angela Dispenzieri; Chinami Miyazaki; Martha Lacy; Christopher G Scott; Jae K Oh; Fletcher A Miller
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  23     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-25     Completed Date:  2010-08-20     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  643-52     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Amyloidosis / blood,  complications,  mortality*
Biological Markers / blood
Echocardiography, Doppler
Longitudinal Studies
Middle Aged
Prospective Studies
Survival Analysis
Ventricular Dysfunction, Left / blood,  diagnosis*,  etiology,  mortality*
Grant Support
Reg. No./Substance:
0/Biological Markers
Comment In:
J Am Soc Echocardiogr. 2010 Jun;23(6):653-5   [PMID:  20497862 ]

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