Intramyocardial inflammation predicts adverse outcome in patients with cardiac AL amyloidosis

Siegismund, Christine S.; Escher, Felicitas; Laßner, Dirk; Kühl, Uwe; Gross, Ulrich; Fruhwald, Friedrich; Wenzel, Philip; Münzel, Thomas; Frey, Norbert; Linke, Reinhold P.; Schultheiss, Heinz‐Peter

doi:10.1002/ejhf.1039

Cited by 50 publications

(41 citation statements)

References 29 publications

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“…It has a poor prognosis further worsened when myocardial inflammation is present. 184 Transthyretin amyloidosis (ATTR) represents about 20% of CA and commonly occurs in elderly patients, including those with severe aortic stenosis. 185 Different phenotypes of ATTR, including hereditary forms associated with specific mutations, have been identified.…”

Section: Amyloidosismentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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Section: Amyloidosismentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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“…This study is the first to focus on the presence of myocardial inflammation in CA and it reveals interesting, novel and surprising findings . The sophisticated techniques used to characterize myocardial inflammation and the identification of specific cell types (CD3+ and LFA‐1+ lymphocytes) associated with worse survival are particular strengths.…”

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confidence: 91%

“…Regrouping patients according to amyloidosis class showed a significant impact of AL type on all‐cause mortality. However, when patients were stratified into those with AL amyloidosis with or without inflammation and those with ATTR amyloidosis with or without inflammation, the presence of inflammation did not affect prognosis in ATTR amyloidosis, but did differentiate those patients with AL amyloidosis with inflammation from other groups …”

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confidence: 91%

“…In this issue of the Journal, Siegismund et al . draw our attention to the incidence of myocardial inflammation in a series of patients with CA submitted to endomyocardial biopsy (EMB) between 2003 and 2015.…”

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confidence: 99%

“…draw our attention to the incidence of myocardial inflammation in a series of patients with CA submitted to endomyocardial biopsy (EMB) between 2003 and 2015. The authors, who have extensive experience in inflammatory heart muscle diseases, describe the survival of a group of 54 biopsy‐proven AL and ATTR CA patients in whom myocardial inflammation was assessed to determine whether inflammation was associated with adverse outcomes . The first surprising finding was the high incidence of intramyocardial inflammation, in almost half the patients (48.1%).…”

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confidence: 99%

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Inflammation in cardiac amyloidosis: prognostic marker or therapeutic target?

Sinagra

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European J of Heart Fail

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Heart failure in the last year: progress and perspective

et al. 2020

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Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM‐HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA‐HF and EMPEROR‐Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65–0.85; P < 0.001 and HR 0.75; 95% CI 0.65–0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82–0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.

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Intramyocardial inflammation predicts adverse outcome in patients with cardiac AL amyloidosis

Cited by 50 publications

References 29 publications

Highlights in heart failure

Highlights in heart failure

Inflammation in cardiac amyloidosis: prognostic marker or therapeutic target?

Heart failure in the last year: progress and perspective

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