Abstract
Background: Optimal heart rate (HR) that associates with higher cardiac output and greater clinical outcomes in patients with cardiac amyloidosis remains unknown. Methods: Consecutive patients with sinus rhythm who were diagnosed with cardiac amyloidosis at our institute between February 2015 and February 2021 were retrospectively included. Ideal HR, at which E-wave and A-wave stand adjacent without any overlaps in the trans-mitral flow echocardiography, was calculated by the formula: 86.8−0.08 × deceleration time (msec). The association between optimal HR and cardiac death or heart failure readmission was investigated. Results: Ten patients (median 74 years old, 8 men) were included. On median, actual HR was 64 bpm and ideal HR was 69 bpm. An incidence rate of the primary endpoint in the sub-optimal HR group tended to be higher than optimal HR group: one of the four patients in optimal HR group had events (25%); two of the two patients in higher HR group had events (100%); two of the four patients in lower HR group had events (50%). Conclusions: The optimal HR was associated with greater clinical outcomes in patients with cardiac amyloidosis. The clinical impact of aggressive HR optimization in this cohort remains the next concern.
Highlights
With greater progress in imaging technology and its incremental awareness, the number of patients diagnosed with cardiac amyloidosis has dramatically increased [1,2].therapeutic strategy for them remains unestablished [3,4,5].Low cardiac output, which is associated with severe diastolic dysfunction by the intramyocardial deposition of amyloid, is one of the critical comorbidities
We investigated the association between optimal heart rate (HR), which was calculated using a formula that was derived based on the previously proposed concept, and clinical outcomes in patients with cardiac amyloidosis
Eight patients were diagnosed with transthyretin amyloidosis and the other two patients were lightchain amyloidosis
Summary
With greater progress in imaging technology and its incremental awareness, the number of patients diagnosed with cardiac amyloidosis has dramatically increased [1,2]. Our team recently found that a “zero” overlap between E wave and A wave in the trans-mitral echocardiography flow was associated with maximum cardiac output and greater clinical outcomes in patients with systolic heart failure [7]. We expanded this concept and proposed formulas to estimate optimal HR using deceleration time alone for those with preserved ejection fraction (HFpEF) [7,8,9]. We investigated the association between optimal HR, which was calculated using a formula that was derived based on the previously proposed concept, and clinical outcomes in patients with cardiac amyloidosis
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