Journal Article

Change in N-terminal pro-B-type natriuretic peptide at 1 year predicts mortality in wild-type transthyretin amyloid cardiomyopathy

Cohen, Oliver C, Hutt, David F, Petrie, Aviva, Ravichandran, Sriram, Law, Steven, Martinez-Naharro, Ana, Hawkins, Philip N, Gillmore, Julian D, Whelan, Carol J, Rowczenio, Dorota, Lachmann, Helen J, Fontana, Marianna, Gilbertson, Janet A, Wechalekar, Ashutosh D, Chacko, Liza

2022

Overview

ObjectivesWild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) is a progressive and fatal condition. Although prognosis can be determined at the time of diagnosis according to National Amyloidosis Centre (NAC) transthyretin amyloidosis (ATTR) stage, the clinical course varies substantially between individuals. There are currently no established measures of rate of disease progression. Through systematic analysis of functional, biochemical and echocardiographic disease-related variables we aimed to identify prognostic markers of disease progression in wtATTR-CM.MethodsThis is a retrospective observational study of 432 patients with wtATTR-CM diagnosed at the UK NAC, none of whom received disease-modifying therapy. The association between mortality from the 12-month timepoint and change from diagnosis to 12 months in a variety of disease-related variables was explored using Cox regression.ResultsChange in N-terminal pro-B-type natriuretic peptide concentration (∆ NT-proBNP) at 12 months from diagnosis was the strongest predictor of ongoing mortality and was independent of both change in other disease-related variables (HR 1.04 per 500 ng/L increase (95% CI 1.01 to 1.07); p=0.003) and a range of known prognostic variables at the time of diagnosis (HR 1.07 per 500 ng/L increase (95% CI 1.02 to 1.13); p=0.007). An increase in NT-proBNP of >500 ng/L, >1000 ng/L and >2000 ng/L during the first year of follow-up occurred in 45%, 35% and 16% of patients, respectively.ConclusionChange in NT-proBNP concentration during the first year of follow-up is a powerful independent predictor of mortality in wtATTR-CM.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Amyloidosis / Biomarkers / Blood pressure / cardiomyopathies / Cardiomyopathies - diagnosis / Cardiomyopathy / Disease Progression / Ejection fraction / Heart failure / Heart Failure and Cardiomyopathies / Humans / Kidney diseases / Medical prognosis / Mortality / Natriuretic Peptide, Brain / Patients / Peptide Fragments / Peptides / Prealbumin - genetics / Prognosis / Regression analysis / Scintigraphy / Variables