Cardiac Dysautonomia Predicts Long-Term Survival in Hereditary Transthyretin Amyloidosis After Liver Transplantation.

Détails

ID Serval
serval:BIB_34D2458B8E36
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Cardiac Dysautonomia Predicts Long-Term Survival in Hereditary Transthyretin Amyloidosis After Liver Transplantation.
Périodique
JACC. Cardiovascular imaging
Auteur(s)
Algalarrondo V., Antonini T., Théaudin M., Chemla D., Benmalek A., Lacroix C., Castaing D., Cauquil C., Dinanian S., Eliahou L., Samuel D., Adams D., Le Guludec D., Slama M.S., Rouzet F.
ISSN
1876-7591 (Electronic)
ISSN-L
1876-7591
Statut éditorial
Publié
Date de publication
12/2016
Peer-reviewed
Oui
Volume
9
Numéro
12
Pages
1432-1441
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article
Publication Status: ppublish
Résumé
This study sought to compare techniques evaluating cardiac dysautonomia and predicting the risk of death of patients with hereditary transthyretin amyloidosis (mATTR) after liver transplantation (LT).
mATTR is a multisystemic disease involving mainly the heart and the peripheral nervous system. LT is the reference treatment, and pre-operative detection of high-risk patients is critical. Cardiovascular dysautonomia is commonly encountered in ATTR and may affect patient outcome, although it is not known yet which technique should be used in the field to evaluate it.
In a series of 215 consecutive mATTR patients who underwent LT, cardiac dysautonomia was assessed by a dedicated clinical score, time-domain heart rate variability, (123)-meta-iodobenzylguanidine heart/mediastinum ((123)-MIBG H/M) ratio on scintigraphy, and heart rate response to atropine (HRRA).
Patient median age was 43 years, 62% were male and 69% carried the Val30Met mutation. Cardiac dysautonomia was documented by at least 1 technique for all patients but 6 (97%). In univariate analysis, clinical score, (123)-MIBG H/M ratio and HRRA were associated with mortality but not heart rate variability. The (123)-MIBG H/M ratio and HRRA had greater area under the curve (AUC) of receiver-operating characteristic curves than clinical score and heart rate variability (AUC: 0.787, 0.748, 0.656, and 0.523, respectively). Multivariate score models were then built using the following variables: New York Heart Association functional class, interventricular septum thickness, and either (123-)MIBG H/M ratio (SMIBG) or HRRA (Satropine). AUC of SMIBG and Satropine were greater than AUC of univariate models, although nonsignificantly (AUC: 0.798 and 0.799, respectively). Predictive powers of SMIBG, Satropine, and a reference clinical model (AUC: 0.785) were similar.
Evaluation of cardiac dysautonomia is a valuable addition for predicting survival of mATTR patients following LT. Among the different techniques that evaluate cardiac dysautonomia, (123)-MIBG scintigraphy and heart rate response to atropine had better prognostic accuracy. Multivariate models did not improve significantly prediction of outcome.

Mots-clé
3-Iodobenzylguanidine/administration & dosage, Adult, Amyloid Neuropathies, Familial/diagnosis, Amyloid Neuropathies, Familial/genetics, Amyloid Neuropathies, Familial/mortality, Amyloid Neuropathies, Familial/surgery, Area Under Curve, Atropine/administration & dosage, Autonomic Nervous System/physiopathology, DNA Mutational Analysis, Diagnostic Techniques, Cardiovascular, Female, Genetic Predisposition to Disease, Heart/innervation, Heart Diseases/diagnosis, Heart Diseases/genetics, Heart Diseases/mortality, Heart Diseases/physiopathology, Heart Rate/drug effects, Humans, Liver Transplantation/adverse effects, Liver Transplantation/mortality, Male, Multivariate Analysis, Muscarinic Antagonists/administration & dosage, Mutation, Neurologic Examination, Phenotype, Prealbumin/genetics, Predictive Value of Tests, Primary Dysautonomias/diagnosis, Primary Dysautonomias/genetics, Primary Dysautonomias/mortality, Primary Dysautonomias/physiopathology, Proportional Hazards Models, ROC Curve, Radiopharmaceuticals/administration & dosage, Registries, Retrospective Studies, Risk Factors, Treatment Outcome, cardiac amyloidosis, cardiac dysautonomia, cardiac imaging, liver transplantation, transthyretin
Pubmed
Web of science
Création de la notice
16/11/2017 12:55
Dernière modification de la notice
20/08/2019 14:21
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