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Prognostic value of left ventricular global constructive work in patients with cardiac amyloidosis

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Abstract

Purpose

The aim of the present study was to evaluate the role of ejection fraction (EF), left ventricular (LV) global longitudinal strain (LVGLS) and global constructive work (GCW) as prognostic variables in patients with cardiac amyloidosis (CA).

Methods

CA patients were retrospectively identified between 2015 and 2021 at a tertiary care hospital. Comprehensive clinical, biochemical, and imaging evaluation including two-dimensional (2D) echocardiography with myocardial work (MW) analysis was performed. A clinical combined endpoint was defined as all-cause mortality and heart failure readmission.

Results

70 patients were followed for 16 (7–37) months and 37 (52.9%) reached the combined endpoint. Patient with versus without clinical events had a significantly lower LVEF (40.71% vs. 48.01%, p = 0.039), LVGLS (-9.26 vs. -11.32, p = 0.034) and GCW (1034.47mmHg% vs. 1424.86mmHg%, p = 0.011). Multivariable analysis showed that LVEF ( odds ratio (OR): 0.904; 95% confidence interval (CI): 0.839–0.973, p = 0.007), LVGLS ( OR: 0.620; 95% CI: 0.415–0.926, p = 0.020) and GCW ( OR: 0.995; 95% CI: 0.990–0.999, p = 0.016) were significant predictors of outcome, but the model including GCW had the best discriminative ability to predict the combined endpoint (C-index = 0.888). A GCW less than 1443mmHg% was able to predict the clinical endpoint with a sensitivity of 94% and a specificity of 64% (Area under the curve (AUC): 0.771 (95% CI: 0.581–0.961; p = 0.005)).

Conclusion

In CA patients, GCW may be of additional prognostic value to LVEF and GLS in predicting heart failure hospitalization and all-cause mortality.

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Authors and Affiliations

  1. Centrum voor Hart- en Vaatziekten (CHVZ), Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Jolien Geers, Maria-Luiza Luchian, Andreea Motoc, Jari De Winter, Bram Roosens, Frederik H. Verbrugge, Caroline Weytjens, Bernard Cosyns & Steven Droogmans

  2. Department of Clinical Biology, Laboratory of Clinical Neurochemistry, Center for Neurosciences, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Maria Bjerke & Mandy M. J. Wittens

  3. Department of Clinical Biology, Research Group Experimental Pharmacology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Ann Van Eeckhaut & Ilse Weets

  4. Department of Clinical Biology, Laboratory of Hematology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Simke Demeester

  5. Department of Pathology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Ramses Forsyth

  6. Department of Human Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Thomy de Ravel

  7. Department of Neurology, Center for Neurosciences, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Véronique Bissay

  8. Department of Hematology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Rik Schots

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  1. Jolien Geers
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Correspondence to Jolien Geers.

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Geers, J., Luchian, ML., Motoc, A. et al. Prognostic value of left ventricular global constructive work in patients with cardiac amyloidosis. Int J Cardiovasc Imaging 39, 585–593 (2023). https://doi.org/10.1007/s10554-022-02762-1

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