| Left atrial size is an independent predictor of overall survival in patients with primary systemic amyloidosis. | |
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MedLine Citation:
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PMID: 22152513 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Primary systemic amyloidosis is a severe plasma cell disorder characterized by the extracellular deposition of amyloid fibrils in different organs. Echocardiography is usually performed to assess cardiac involvement. We hypothesized that in patients with systemic amyloidosis, simple echocardiographic measurement of the left atrial (LA) diameter indexed to the body surface area might provide an important risk marker for this disease. METHODS: Between 1997 and 2011, 134 patients were diagnosed with primary systemic amyloidosis and had echocardiography within 28 days; we collected their baseline characteristics and biological and echocardiographic data retrospectively. LA enlargement was defined as recommended as M-mode LA diameter greater or equal to 23mm/m(2). RESULTS: One hundred and eleven patients (83%) had echocardiographic LA dimension data available (mean age 63±11 years; 61% men; 31% previously diagnosed with systemic hypertension). Mean left ventricular ejection fraction (LVEF) and interventricular septum thickness (IVST) were 62±12% and 14±4mm, respectively. Mean follow-up was 2.8±2.9 years (maximum 12 years). Patients with LA enlargement had a slightly lower LVEF (P=0.08) and a significantly greater IVST (P<0.0001). Overall, 5-year survival was 57±5%. However, 1-year and 5-year survival rates were markedly reduced in patients with LA enlargement versus those without LA enlargement (61±7% and 39±8% vs 83±5% and 72±7%, respectively; P=0.0007). On multivariable analysis, after adjusting for age, sex, LVEF, IVST, presence of hypertension and creatinine concentration, LA enlargement remained an independent predictor of overall mortality at 5 years (hazard ratio 2.47; 95% confidence interval 1.11-5.90; P=0.02). CONCLUSION: LA enlargement, a surrogate marker of diastolic dysfunction, is an independent predictor of long-term mortality and may therefore help to enhance risk stratification and management of patients presenting with amyloidosis. |
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Authors:
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Dania Mohty; Philippe Pibarot; Jean G Dumesnil; Nicole Darodes; David Lavergne; Najmeddine Echahidi; Patrice Virot; Dominique Bordessoule; Arnaud Jaccard |
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Publication Detail:
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Type: Journal Article Date: 2011-11-23 |
Journal Detail:
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Title: Archives of cardiovascular diseases Volume: 104 ISSN: 1875-2128 ISO Abbreviation: Arch Cardiovasc Dis Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-13 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101465655 Medline TA: Arch Cardiovasc Dis Country: Netherlands |
Other Details:
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Languages: eng Pagination: 611-8 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Elsevier Masson SAS. All rights reserved. |
Affiliation:
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Pôle « cœur-poumon-rein », service cardiologie, hôpital Dupuytren, CHU de Limoges, 87042 Limoges, France. |
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