Abstract 16164: Left Ventricular Ejection Fraction Matters in Transthyretin Amyloidosis Cardiomyopathy

Abstract

Introduction: Patients with transthyretin cardiac amyloidosis (ATTR-CM) are risk stratified using the Mayo Clinic Prognostic Model. Prior studies showed global longitudinal strain’s (GLS) role in predicting mortality. However, frequently, arrythmias and poor image quality limit GLS quantification. Given GLS and LVEF correlation, we sought to assess the prognostic value of LVEF in addition to Mayo staging in patients with ATTR-CM. Methods: A single center observational cohort study of patients who had been seen at our Amyloidosis Center with ATTR-CM diagnosed between 2005-2019. LVEF was assessed using Simpson’s bi-plane method. Mayo Stages were classified as follows (NTproBNP and Troponin I thresholds 3000 pg/ml and 0.1 ng/ml, respectively): Stage I (both values < threshold), Stage II (either ≥ threshold) and Stage III (both ≥ threshold). The primary outcome was all-cause mortality. Results: Ninety-one patients with ATTR-CM (mean age 73±10 years, 92% male) had a median (IQR) follow-up of 28 (15, 45) months, and 25 (28%) patients died. Mayo Stage distribution in patients with LVEF <50% vs LVEF ≥50% was 33% vs 66% (Stage I), 40% vs 24% (Stage II), and 27% vs 10% (Stage III) (Fisher’s exact, p=0.03). Thirty-seven (41%) had LVEF <50% of whom 35% died as compared to 53 (59%) with LVEF ≥50% of whom 23% died, (log-rank, p=0.02; Figure). Results from univariable and multivariable Cox Proportional Hazard models are shown in Table. Conclusions: LVEF provides incremental prognostic information to the Mayo classification.