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Poor right ventricular function is associated with impaired exercise capacity and ventilatory efficiency in transthyretin cardiac amyloid patients

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Abstract

CardioPulmonary Exercise Test (CPET) is the gold standard to evaluate functional capacity in patients at high risk of heart failure (HF). Few studies with a limited number of subjects and conflicting results, analyzed the role of CPET in patients with systemic amyloidosis. Aims of our study were the assessment of the response to exercise in patients with Transthyretin amyloid (ATTR) cardiomyopathy (CA), and the correlation of clinical, biohumoral and echocardiographic parameters with CPET parameters, such as VO2 peak and VE/VCO2 slope. From February 2018 to March 2019, 72 cardiac ATTR patients were prospectively enrolled and underwent a complete clinical, biohumoral, echocardiographic and CPET assessment. All patients completed the exercise stress test protocol, without any adverse event. At CPET, they achieved a mean VO2 peak of 14 mL/Kg/min and a mean VE/VCO2 slope of 31. The blood pressure response to exercise was inadequate in 26 (36%) patients (flat in 25 and hypotensive in 1), while 49/72 patients (69%) showed an inadequate heart rate recovery. In multivariate analysis, s’ tricuspidalic was the only independent predictor of VO2 peak, while in the two test models performed to avoid collinearity, both TAPSE and s’ tricuspidalic were the strongest independent predictors of VE/VCO2 slope. Our data demonstrate the role of right ventricular function as an independent predictor of exercise capacity and ventilatory efficiency in ATTR. In CPET evaluation, a significant proportion of patients presented an abnormal arterial pressure response and heart rate variation to exercise.

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Author notes

  1. Simone Bartolini and Samuele Baldasseroni contributed equally to this manuscript.

Authors and Affiliations

  1. Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy

    Simone Bartolini, Federico Perfetto, Raffaele Martone, Giulia Taborchi, Sofia Morini, Elisa Vignini & Francesco Cappelli

  2. Cardiology Department, Azienda Sanitaria Firenze (ASF), Florence, Italy

    Simone Bartolini

  3. Geriatric Medicine and UTIG, Azienda Ospedaliera Careggi, Florence, Italy

    Samuele Baldasseroni

  4. Cardiac Rehabilitation Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Francesco Fattirolli, Maria Vittoria Silverii & Lucrezia Piccioli

  5. Department of Experimental and Clinical Medicine, Division of General Cardiology, University of Florence, Careggi University Hospital, Florence, Italy

    Niccolò Marchionni & Carlo Di Mario

  6. Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy

    Carlo Di Mario & Francesco Cappelli

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  1. Simone Bartolini
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Correspondence to Francesco Cappelli.

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Human and animal rights statement

This study was approved by the Regional Ethics Committee (protocol number 11171), and was conducted in accordance with the Declaration of Helsinki and the International Conference on Harmonisation Good Clinical Practice guidelines.

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On enrolment, all patients gave their written informed consent to participate in the study.

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Bartolini, S., Baldasseroni, S., Fattirolli, F. et al. Poor right ventricular function is associated with impaired exercise capacity and ventilatory efficiency in transthyretin cardiac amyloid patients. Intern Emerg Med 16, 653–660 (2021). https://doi.org/10.1007/s11739-020-02474-1

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