Abstract 16542: Predictors of Mortality in Patients With Light Chain (AL) Amyloidosis Heart Failure: A Multi-variate Analysis
Background: AL deposition in the heart occurs in about half of all patients affected by systemic AL amyloidosis, conferring an extremely poor prognosis. Cardiac involvement in AL amyloid (AL-CMP) may result in clinical heart failure (HF). Once HF occurs, the median survival is ~6 months if untreated. We thus sought to determine clinical characteristics and predictors of mortality in AL-CMP with HF.
Methods: Between 2004-2014, patients with biopsy-proven AL-CMP, Stage C HF and without prior immunosuppressive therapy were enrolled at first visit to the Amyloid Clinic at Boston University Medical Center. Routine laboratory tests, physical examination and echocardiography were performed.
Results: The AL-CMP cohort comprised of 165 patients. Mean age was 61.6±9.8 yrs., predominantly white (76.4%) and 60.6% were men. Median time to survival was 10.9 months (95% CI 6.2, 14.7) Figure 1. Age, atrial fibrillation, NYHA class, CRP, BNP, LV ejection fraction, relative wall thickness and intraventricular septum size were independent predictors of all cause mortality in univariate analysis. Only age [HR 1.04 (1.01-1.06)], log BNP [HR 1.45 (1.15-1.8)], CRP [HR 1.02 (1.00-1.04)], NYHA class [HR 1.50 (1.02-2.2)] and relative wall thickness [HR 6.70 (2.45-18.30)] were predictors of all cause mortality in multivariate analysis (P<0.05).
Conclusions: In addition to using cardiac biomarkers such as BNP and troponin, which are predictors of prognosis and are used to guide staging and treatment in AL amyloidosis, we identified additional prognostic markers once patients with AL cardiac amyloid develop HF. Relative wall thickness is the strongest predictor of mortality. These markers can be used to help identify AL cardiac amyloid patients with HF at greatest risk for poor outcomes.
Author Disclosures: U. Tahir: None. G. Doros: None. J.S. Kim: None. L.H. Connors: None. F. Sam: None.
- © 2015 by American Heart Association, Inc.