Abstract
The aim of this study is to evaluate the prognostic value of cardiopulmonary testing (CPET) in a cohort of patients with transthyretin cardiac amyloidosis (ATTR-CA). ATTR-CA is associated with a progressive reduction in functional capacity. The prognostic role of CPET parameters and in particular of normalized peak VO2 (%ppVO2) remains to be thoroughly evaluated. In this study, 75 patients with ATTR-CA underwent cardiological evaluation and CPET in a National Referral Center for cardiac amyloidosis (Careggi University Hospital, Florence). Fifty-seven patients (76%) had wild-type ATTR. Median age was 80 (75–83) years, 68 patients (91%) were men. Peak oxygen consumption (14.1 ± 4.1 ml/kg/min) and %ppVO2 (68.4 ± 18.8%) were blunted. Twenty-seven (36%) patients had an abnormal pressure response to exercise. After a median follow-up of 25 (12–31) months, the composite outcome of death or heart failure hospitalization was registered in 19 (25.3%) patients. At univariate analysis %ppVO2 was a stronger predictor for the composite outcome than peak VO2. %ppVO2 and NT-proBNP remained associated with the composite outcome at multivariate analysis. The optimal predictive threshold for %ppVO2 was 62% (sensitivity: 71%; specificity: 68%; AUC: 0.77, CI 0.65–0.88). Patients with %ppVO2 ≤ 62%and NT-proBNP > 3000 pg had a worse prognosis with 1- and 2-year survival of 69 ± 9% and 50 ± 10%, respectively. CPET is a safe and useful prognostic tool in patients with ATTR-CA. CPET may help to identify patients with advanced disease that may benefit from targeted therapy.
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Abbreviations
- HF:
-
Heart failure
- AT:
-
Anaerobic threshold
- ATTR-CA:
-
Transthyretin cardiac amyloidosis
- ATTRwt:
-
Wild-type transthyretin cardiac amyloidosis
- ATTRv:
-
Hereditary transthyretin cardiac amyloidosis
- CPET:
-
Cardiopulmonary exercise testing
- HFpEF:
-
HF with preserved ejection fraction
- LV:
-
Left ventricle/ventricular
- %ppVO2 :
-
Percentage of predicted peak VO2
- SV:
-
Stroke volume
- VO2 :
-
Oxygen uptake
- VCO2 :
-
Carbon dioxide production
- VE/VCO2 slope:
-
Minute ventilation/carbon dioxide production
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MVS and AA: methodology, investigation, data curation and formal analysis, writing—original draft. SB, CF and MZ: conceptualization, methodology, investigation, data curation and formal analysis, writing—original draft. SB and CM: data curation and formal analysis, writing—original draft. CDM, NM, IO: writing—review and editing. AT, LG and CB: resources and data curation. FF, FC and FP: conceptualization, methodology, writing—review and editing, supervision.
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Silverii, M.V., Argirò, A., Baldasseroni, S. et al. Prognostic value of cardiopulmonary exercise testing in patients with transthyretin cardiac amyloidosis. Intern Emerg Med 18, 585–593 (2023). https://doi.org/10.1007/s11739-022-03125-3
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DOI: https://doi.org/10.1007/s11739-022-03125-3