Abstract 17230: Plasma BNP and Serum Sodium Correlate With Left Ventricular Ejection Fraction in Light Chain (AL) Cardiac Amyloidosis
Background: Cardiac involvement and heart failure (HF) in AL amyloidosis portends an extremely poor prognosis with a survival of <6 months if untreated. N-terminal pro-BNP may predict cardiac involvement and prognosis in AL amyloidosis; however, in patients with non-amyloid systolic HF, BNP is associated only with NYHA functional class and in-hospital mortality. No relationship between BNP and left ventricular (LV) function has been identified. Patients with AL amyloidosis in HF often have relatively preserved LV function. Here we test the hypothesis that the BNP level in AL cardiac amyloidosis on initial presentation is associated with LV dysfunction.
Methods: Between 2005–2009, patients with biopsy-proven amyloidosis were enrolled at first visit to the Amyloid Clinic at Boston Medical Center. Routine laboratory tests, physical examination, and echocardiography were performed.
Results: A total of 101 AL cardiac amyloid patients were identified. Patients were not on standard HF therapy, but 82% were on a loop diuretic. Patients were 68% male and 81% white with a mean age of 63±9 years (range 36 to 83 years). Mean values for LV ejection fraction (EF) and BNP were 48±12% and 1072±1230pg/mL, respectively. Median BNP level was used to divide the cohort into two groups, Group 1 (BNP ≤ 670 pg/ml) and Group 2 (BNP > 670 pg/ml). By multivariate linear regression analysis, sodium and BNP remained significant determinants of LVEF; MDRD GFR and age were not correlated with LVEF.
Conclusion: In AL cardiac amyloidosis increased plasma BNP and decreased serum sodium levels at initial presentation are predictive of a lower LVEF and may discriminate the sicker patients. These biomarkers may be part of the armamentarium used for patient selection with regard to therapy for AL cardiac amyloidosis
- © 2010 by American Heart Association, Inc.