Abstract 13355: Risk Factors and Prognostic Role of Left Atrial Enlargement in Patients With Light-chain Cardiac Amyloidosis
Introduction: Cardiac AL amyloidosis carries a poor prognosis so early diagnosis is essential for effective disease-modifying therapy. Echocardiography is a non-invasive modality used for evaluating cardiac diastolic dysfunction, which appears to be a convenient examination. Left atrium (LA), a characteristic of diastolic feature, plays a role in modulating cardiovascular performance. As part of routine clinical examination, we adopted LA diameter indexed to body surface area (LADi) as the parameter to evaluating LA size. Therefore, we aimed to assess risk factors and prognostic values of LA size measured by a simple echocardiographic index in cardiac AL amyloidosis.
Methods: A retrospective analysis of patients with biopsy-proven cardiac AL amyloidosis was conducted. LA enlargement was defined as LADi greater than 23mm/m2.
Results: A total of 104 cardiac AL amyloidosis patients were included in the final analysis, 61(58.7%) of which showed a presentation of LA enlargement. 64.4% were males, mean age was 55 ± 12 y and 57.7% were accompanied with severe heart failure (HF) (NYHA III to IV). Age, NYHA, ejection fraction (EF) and early/late mitral velocity ratio (E/A ratio) were independently associated with LA enlargement in the univariate analysis. But after fitting a multivariate logistic model, NYHA and EF did not remain in the final analysis. During a mean follow-up period of 39 months, the overall survival was significantly shorter in the group with a larger LA (median 5 months vs 22 months, p<0.001). LA enlargement was related with all-cause mortality with a hazard ratio of 1.94 (95%CI: 1.14-3.29, p=0.015) and was also a risk factor of severe HF (hazard ratio 2.18, 95%CI: 1.12-4.23, p=0.022).
Conclusion: In cardiac AL amyloidosis, age and E/A ratio were main independent risk factors regarding LA enlargement. LA enlargement, evaluated by LADi, seemed to be related to prevalence and incidence of severe HF and was also a significant predictor of mortality.
Author Disclosures: L. Zhao: None. Z. Tian: None. Q. Fang: None.
- © 2015 by American Heart Association, Inc.