Abstract 17880: Dynamic Changes in Cardiac Mechanics in AL Amyloidosis and Its Relationship to Immunologic Response to Chemotherapy
Background: Cardiac involvement is common in patients with Light Chain (AL) Amyloidosis and portends a poor prognosis. Little is known about the changes in cardiac mechanics following chemotherapy.
Hypothesis: We assessed the hypothesis that immunologic response to chemotherapy is associated with improvement in cardiac mechanics.
Methods: We identified 41 consecutive patients from the Stanford AL Amyloidosis database who had Echocardiograms and free light chain (FLC) values before and after chemotherapy. Echocardiographic assessment included global longitudinal strain (GLS), LV diastolic function metrics, and left atrial (LA) stiffness. Forty age and sex-matched controls were included. Immunologic response to chemotherapy was defined as ≥50% reduction in the difference between the involved and uninvolved FLC. Structural and functional improvement was defined as >10% improvement in cardiac parameters based on the inter-reader variability in our laboratory.
Results: The mean age was 66.9 ± 8.4 years and 66% were male. Compared to controls, atrial and ventricular mechanics were significantly impaired in patients with cardiac amyloidosis. Higher Mayo stage was associated with worse GLS, E/e’ and LA stiffness. The average time to post-chemotherapy Echocardiogram was 9.2 ± 3.6 months. There was no significant change in myocardial remodeling and functional parameters following chemotherapy in the cohort overall, however individual responses showed considerable variability. Immunologic response was seen in 30 (73%) of patients. Improvement in E/e’ and LA stiffness was associated with immunologic response to chemotherapy (p = 0.028, p = 0.006 respectively) while there was a trend for GLS (p = 0.056).
Conclusion: Improvement in diastolic parameters and LA stiffness are associated with immunologic response. Further studies with longer follow-up intervals are needed to explore the full range of atrial and ventricular remodeling following chemotherapy.
Author Disclosures: M. Tuzovic: None. Y. Kobayashi: None. M. Wheeler: None. M. Liedtke: None. F. Haddad: None. R. Witteles: None.
- © 2016 by American Heart Association, Inc.