Abstract 9312: Predictors of Survival in Primary Cardiac Amyloidosis
Background: Cardiac involvement in primary amyloidosis (AL) is associated with poor prognosis. We studied the prognostic significance of clinical, ECG and echocardiographic parameters of patients with primary cardiac amyloidosis.
Methods: 60 patients with primary amyloidosis and cardiac involvement documented by endomyocardial tissue biopsy were studied.
Results: 60 patients (mean age 57.94±10.22 years; 71.67% male and 86.67% Caucasian) were studied. The median survival was 12.23 (median) ±4.43 months, 50% of patients survived for more than 1 year. Congestive heart failure (NYHA II-IV) was present in 60% of patients. Low voltage, Q wave, conduction abnormalities, first degree AV block and abnormal QRS axis were present in 54.24%, 51.72%, 71.67%, 21.67% and 57.72% respectively. Echocardiogram revealed LVH, mitral regurgitation, left atrial enlargement, speckled appearance and pericardial effusion in 82.76%, 62%, 63.16%, 8.77% and 42.11% respectively. LVEF, RVSP, IVS and LVPW were 0.479±.129, 40.88±10.31 mmHg, 1.46±0.34 cm and 1.43±0.33cm respectively. CHF (NYHA II-IV), IVS, LVPW and LVEF were significant on univariate survival analysis (p<0.05). Multivariate predictors of survival were CHF (NYHA II-IV) ( p=0.027, HR 3.04 [95% CI: 1.1-8.1]) and IVS< 1.5cm (p=0.012, HR:3.51 [95% CI: 1.3-9.3]). Median survival of patients with CHF (NYHA II-IV) was 7.58±1.74 months contrary to those without CHF who had a median survival of 31.2±11.41 months.
Conclusion: In patients with primary amyloidosis and cardiac involvement, lenght of survival is strongly associated with CHF (NYHA II-IV) and IVS thickness compared to other electrographic and echocardiographic parameters.
- © 2012 by American Heart Association, Inc.