Different NT-proBNP circulating levels for different types of cardiac amyloidosis

Perfetto, Federico; Bergesio, Franco; Grifoni, Elisa; Fabbri, Alessia; Ciuti, Gabriele; Frusconi, Sabrina; Angelotti, Paola; Spini, Valentina; Cappelli, Francesco

doi:10.2459/jcm.0000000000000349

Cited by 28 publications

(26 citation statements)

References 29 publications

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“…Several reports, especially in the AL-related forms, have brought the use of natriuretic peptides changes as an index of response to therapy. Thus, despite similar LV mass and renal function, patients with TTR CA showed lower levels of natriuretic peptides than patients with AL amyloidosis 15. However, in our study, there appears to be a correlation between BNP levels and PCWP.…”

Section: Discussioncontrasting

confidence: 64%

Value of natriuretic peptides and tissue Doppler imaging in the estimation of left ventricular filling pressure in patients with cardiac amyloidosis

et al. 2019

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BackgroundEstimation of left ventricular filling pressures (LVFP) is a determining factor in the follow-up of patients with cardiac amyloidosis (CA). Natriuretic peptides (NPs) and tissue Doppler imaging may be used to monitor LVFP in patients with CA. The aim of this study was to evaluate the value of NPs and Doppler parameters in estimating LVFP in patients with CA.MethodsFifty patients with biopsy-verified light chain (n=31), A protein amyloidosis (AA) (n=1), apoliporotein A2 (n=1) or bone scintigraphy-proven transthyretin (n=17) CA were retrospectively included. All patients underwent right heart catheterisation (RHC). Among them, 48 (96%) and 43 (86%) had assays of NPs (20 brain natriuretic peptide (BNP), 27 N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) and 1 both) and transthoracic echocardiography performed within 24 hours of RHC, respectively.ResultsThe median BNP and NT-proBNP levels were 1000 (243–1477) ng/L and 10 106 (2935–13 348) ng/L, respectively. Echocardiography demonstrated left atrial enlargement with a mean volume of 47±16 mL and low tissue Doppler lateral Ea of 5±2 cm/s. The mean early diastolic mitral inflow velocity on early lateral mitral annular diastolic velocity ratio (E/Ea) ratio was 18±7, and the mean pulmonary capillary wedge pressure (PCWP) by RHC was 18±8 mm Hg. There was no correlation between BNP (r=0.260, p=0.774) or NT-proBNP (r=−0.103, p=0.984) levels and PCWP. There was a slight correlation between E/Ea ratio and PCWP (r=0.337, p=0.029). E/Ea ratio >14 performed poorly in differentiating elevated and low LVFP.ConclusionIn patients with CA, NPs do not accurately estimate PCWP. Tissue Doppler-derived mitral E/Ea ratio is correlated with PCWP, but the slight correlation requires to estimate LVFP in a broad clinical and imaging context to avoid diagnostic errors.

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Section: Discussioncontrasting

confidence: 64%

Value of natriuretic peptides and tissue Doppler imaging in the estimation of left ventricular filling pressure in patients with cardiac amyloidosis

et al. 2019

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“…Circulating light chains exert a direct toxic effect by modulating p38 mitogen-activated protein kinase, which can directly promote NT-pro-BNP expression. 54–56 Thus, for the same range of hemodynamic abnormalities, plasma levels of NT-pro-BNP are higher in AL compared to ATTRwt and ATTRm 53 . An apoptotic effect can cause an elevation of troponins, sometimes leading to false diagnoses of acute coronary syndrome in patients with CA hospitalized for heart failure.…”

Section: Diagnosing Cardiac Amyloidosismentioning

confidence: 94%

“…While many patients with renal failure have increased left ventricular wall thickness and serum β2-microglobulin can be associated with increased wall thickness 51 , beta-2 microglobulin amyloid deposition rarely causes meaningful cardiac dysfunction 52 . Natriuretic peptides tend to be particularly high in CA, often out of proportion from the hemodynamic burden 53 . Circulating light chains exert a direct toxic effect by modulating p38 mitogen-activated protein kinase, which can directly promote NT-pro-BNP expression.…”

Section: Diagnosing Cardiac Amyloidosismentioning

confidence: 99%

Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis

et al. 2017

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Advances in cardiac imaging have resulted in greater recognition of cardiac amyloidosis (CA) in everyday clinical practice, but the diagnosis continues to be made in patients with late stage disease, suggesting that more needs to be done to improve awareness of its clinical manifestations and the potential of therapeutic intervention to improve prognosis. Light chain CA (AL-CA) in particular, if recognized early and treated with targeted plasma cell therapy, can be managed very effectively. For patients with transthyretin amyloidosis, there are numerous therapies that are currently in late phase clinical trials. In this review we address common questions encountered in clinical practice regarding etiology, clinical presentation, diagnosis and management of cardiac amyloidosis, focusing on recent important developments in cardiac imaging and biochemical diagnosis. The aim is to show how a systematic approach to the evaluation of suspected CA can impact the prognosis of patients in the modern era.

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“…67 Cardiac troponins I and T (TnI and TnT), especially high-sensitivity (hs) troponins, are slightly higher in AL than ATTR CA, likely reflecting the greater cytotoxicity of AL precursors. [68][69][70] Studies investigating the diagnostic performance of troponins have yielded conflicting results, probably because of differences in troponin assays and diagnostic criteria for CA. In one study on 63 patients with AL amyloidosis, hs-TnT was not useful for detecting patients with biopsy-proven CA (n = 30).…”

Section: Al Amyloidosismentioning

confidence: 99%

“…After adjustment for left ventricular mass and renal function, NPs are higher in ATTRwt than in ATTRv, possibly because of differences in age and renal function. 69,75,76 In ATTRv, cardiac biomarkers are variably increased according to the presence and severity of cardiac involvement. Subjects with non-V30M mutations have higher NT-proBNP and BNP than those with V30M mutation, which is associated with a prevalent neuropathic phenotype.…”

Section: Attr Amyloidosismentioning

confidence: 99%

Use of biomarkers to diagnose and manage cardiac amyloidosis

Castiglione

Franzini

Aimo

et al. 2021

European J of Heart Fail

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Amyloidoses are characterized by the tissue accumulation of misfolded proteins into insoluble fibrils. The two most common types of systemic amyloidosis result from the deposition of immunoglobulin light chains (AL) and wild-type or variant transthyretin (ATTRwt/ATTRv). Cardiac involvement is the main determinant of outcome in both AL and ATTR, and cardiac amyloidosis (CA) is increasingly recognized as a cause of heart failure. In CA, circulating biomarkers are important diagnostic tools, allow to refine risk stratification at baseline and during follow-up, help to tailor the therapeutic strategy and monitor the response to treatment. Among amyloid precursors, free light chains are established biomarkers in AL amyloidosis, while the plasma transthyretin assay is currently being investigated as a tool for supporting the diagnosis of ATTRv amyloidosis, predicting outcome and monitor response to novel tetramer stabilizers or small interfering RNA drugs in ATTR CA. Natriuretic peptides (NPs) and troponins are consistently elevated in patients with AL and ATTR CA. Plasma NPs, troponins and free light chains hold prognostic significance in AL amyloidosis, and are evaluated for therapy decision-making and follow-up, while the value of NPs and troponins in ATTR is less well established. Biomarkers can be usefully integrated with clinical and imaging variables at all levels of the clinical algorithm of systemic amyloidosis, from screening to diagnosis and prognosis, and treatment tailoring.

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Different NT-proBNP circulating levels for different types of cardiac amyloidosis

Cited by 28 publications

References 29 publications

Value of natriuretic peptides and tissue Doppler imaging in the estimation of left ventricular filling pressure in patients with cardiac amyloidosis

Value of natriuretic peptides and tissue Doppler imaging in the estimation of left ventricular filling pressure in patients with cardiac amyloidosis

Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis

Use of biomarkers to diagnose and manage cardiac amyloidosis

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