Pub Date : 2024-08-01DOI: 10.1016/j.jaccao.2024.03.008
Junzhe Huang MS , Changhui Lei MBBS , David H. Hsi MD , Minjuan Zheng MD, PhD , Hui Ma MBBS , Shengjun Ta MBBS , Rui Hu MS , Chao Han MD, PhD , Wenxia Li MBBS , Jing Li MBBS , Dong Qu MBBS , Fangqi Ruan PhD , Jing Wang MD, PhD , Bo Wang MBBS , Xueli Zhao MBBS , Jiao Liu PhD , Lina Zhao MD, PhD , Zhe Wang MD, PhD , Jian Yang MD, PhD , Liwen Liu MD, PhD
Background
Patients with cardiac tumors may present challenges for surgical resection due to poor clinical condition. Echocardiography-guided transapical radiofrequency ablation for cardiac tumors (TARFACT) potentially offers a less invasive palliative therapy option.
Objectives
This study aimed to evaluate the safety and efficacy of TARFACT.
Methods
Five patients with cardiac tumors (mucinous liposarcoma, myocardial hypertrophy with inflammatory cell infiltration mass, fibrous tissue tumor hyperplasia, myocardial clear cell sarcoma, and cardiac rhabdomyoma) were included. All patients underwent TARFACT and were assessed with electrocardiogram, echocardiographic imaging, biochemical analysis, and pathological confirmation.
Results
The median follow-up for all patients was 9 (range 4-12) months. Three surviving patients were alive at their last follow-up (9, 12, and 12 months, respectively), whereas 2 patients with late-stage tumors survived 6 months and 13 months after TARFACT, respectively. After TARFACT, all patients showed significant reductions in tumor size: the mean length decreased from 6.7 ± 2.0 cm to 4.7 ± 1.8 cm (P = 0.007); and the mean width decreased from 5.0 ± 2.1 cm to 2.5 ± 0.7 cm (P = 0.041). NYHA functional class also improved: median (IQR) decreased from 3.0 (1.5) to 2.0 (1.0) (P = 0.038), Peak E-wave on echocardiography showed a mean increase from 64.4 ± 15.7 cm/s to 76.6 ± 18.6 cm/s (P = 0.008), and NT-pro BNP levels had a median (IQR) reduction from 115.7 (252.1) pg/mL to 55.0 (121.6) pg/mL (P = 0.043).
Conclusions
TARFACT is a novel palliative treatment option for cardiac tumors, reducing accessible tumors and improving clinical symptoms in a preliminary group of patients. (Cardiac Tumors Interventional [Radio Frequency/Laser Ablation] Therapy [CTIH]; NCT02815553)
{"title":"Echocardiography-Guided Radiofrequency Ablation for Cardiac Tumors","authors":"Junzhe Huang MS , Changhui Lei MBBS , David H. Hsi MD , Minjuan Zheng MD, PhD , Hui Ma MBBS , Shengjun Ta MBBS , Rui Hu MS , Chao Han MD, PhD , Wenxia Li MBBS , Jing Li MBBS , Dong Qu MBBS , Fangqi Ruan PhD , Jing Wang MD, PhD , Bo Wang MBBS , Xueli Zhao MBBS , Jiao Liu PhD , Lina Zhao MD, PhD , Zhe Wang MD, PhD , Jian Yang MD, PhD , Liwen Liu MD, PhD","doi":"10.1016/j.jaccao.2024.03.008","DOIUrl":"10.1016/j.jaccao.2024.03.008","url":null,"abstract":"<div><h3>Background</h3><p>Patients with cardiac tumors may present challenges for surgical resection due to poor clinical condition. Echocardiography-guided transapical radiofrequency ablation for cardiac tumors (TARFACT) potentially offers a less invasive palliative therapy option.</p></div><div><h3>Objectives</h3><p>This study aimed to evaluate the safety and efficacy of TARFACT.</p></div><div><h3>Methods</h3><p>Five patients with cardiac tumors (mucinous liposarcoma, myocardial hypertrophy with inflammatory cell infiltration mass, fibrous tissue tumor hyperplasia, myocardial clear cell sarcoma, and cardiac rhabdomyoma) were included. All patients underwent TARFACT and were assessed with electrocardiogram, echocardiographic imaging, biochemical analysis, and pathological confirmation.</p></div><div><h3>Results</h3><p>The median follow-up for all patients was 9 (range 4-12) months. Three surviving patients were alive at their last follow-up (9, 12, and 12 months, respectively), whereas 2 patients with late-stage tumors survived 6 months and 13 months after TARFACT, respectively. After TARFACT, all patients showed significant reductions in tumor size: the mean length decreased from 6.7 ± 2.0 cm to 4.7 ± 1.8 cm (<em>P</em> = 0.007); and the mean width decreased from 5.0 ± 2.1 cm to 2.5 ± 0.7 cm (<em>P</em> = 0.041). NYHA functional class also improved: median (IQR) decreased from 3.0 (1.5) to 2.0 (1.0) (<em>P</em> = 0.038), Peak E-wave on echocardiography showed a mean increase from 64.4 ± 15.7 cm/s to 76.6 ± 18.6 cm/s (<em>P</em> = 0.008), and NT-pro BNP levels had a median (IQR) reduction from 115.7 (252.1) pg/mL to 55.0 (121.6) pg/mL (<em>P</em> = 0.043).</p></div><div><h3>Conclusions</h3><p>TARFACT is a novel palliative treatment option for cardiac tumors, reducing accessible tumors and improving clinical symptoms in a preliminary group of patients. (Cardiac Tumors Interventional [Radio Frequency/Laser Ablation] Therapy [CTIH]; <span><span>NCT02815553</span><svg><path></path></svg></span>)</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 4","pages":"Pages 560-571"},"PeriodicalIF":12.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324001406/pdfft?md5=d5e348eb1c82c9980ac1986cd5c8798a&pid=1-s2.0-S2666087324001406-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jaccao.2024.04.001
Timothy M. Markman MD , John P. Plastaras MD, PhD
{"title":"Cardiac Tumors and Innovations in Local Therapies","authors":"Timothy M. Markman MD , John P. Plastaras MD, PhD","doi":"10.1016/j.jaccao.2024.04.001","DOIUrl":"10.1016/j.jaccao.2024.04.001","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 4","pages":"Pages 572-574"},"PeriodicalIF":12.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324001455/pdfft?md5=438e93ccb99a6fbca952b76d95f3866d&pid=1-s2.0-S2666087324001455-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jaccao.2024.07.003
Katelyn M. Atkins MD, PhD , Andriana P. Nikolova MD, PhD
{"title":"Optimizing Cardiovascular Risk Prediction From CT Imaging at the Radiation Oncology Point of Care","authors":"Katelyn M. Atkins MD, PhD , Andriana P. Nikolova MD, PhD","doi":"10.1016/j.jaccao.2024.07.003","DOIUrl":"10.1016/j.jaccao.2024.07.003","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 4","pages":"Pages 541-543"},"PeriodicalIF":12.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324002217/pdfft?md5=988ca658a87048878a88e1bf8a8e4a71&pid=1-s2.0-S2666087324002217-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jaccao.2024.05.015
Celeste McCracken MSc , Dorina-Gabriela Condurache MBBS , Liliana Szabo MBBS, PhD , Hussein Elghazaly MBBS , Fiona M. Walter MA, MD , Adam J. Mead MBBS, PhD , Ronjon Chakraverty MBBS, PhD , Nicholas C. Harvey MB BChir, PhD , Charlotte H. Manisty MBBS, PhD , Steffen E. Petersen MSc, MPH, MD, DPhil , Stefan Neubauer MBBS , Zahra Raisi-Estabragh MBChB, PhD
Background
Cardiovascular preventive strategies are guided by risk scores with unknown validity in cancer cohorts.
Objectives
This study aimed to evaluate the predictive performance of 7 established cardiovascular risk scores in cancer survivors from the UK Biobank.
Methods
The predictive performance of QRISK3, Systematic Coronary Risk Evaluation 2 (SCORE2)/Systematic Coronary Risk Evaluation for Older Persons (SCORE-OP), Framingham Risk Score, Pooled Cohort equations to Prevent Heart Failure (PCP-HF), CHARGE-AF, QStroke, and CHA2DS2-VASc was calculated in participants with and without a history of cancer. Participants were propensity matched on age, sex, deprivation, health behaviors, family history, and metabolic conditions. Analyses were stratified into any cancer, breast, lung, prostate, brain/central nervous system, hematologic malignancies, Hodgkin lymphoma, and non-Hodgkin lymphoma. Incident cardiovascular events were tracked through health record linkage over 10 years of follow-up. The area under the receiver operating curve, balanced accuracy, and sensitivity were reported.
Results
The analysis included 31,534 cancer survivors and 126,136 covariate-matched controls. Risk score distributions were near identical in cases and controls. Participants with any cancer had a significantly higher incidence of all cardiovascular outcomes than matched controls. Performance metrics were significantly worse for all risk scores in cancer cases than in matched controls. The most notable differences were among participants with a history of hematologic malignancies who had significantly higher outcome rates and poorer risk score performance than their matched controls. The performance of risk scores for predicting stroke in participants with brain/central nervous system cancer was very poor, with predictive accuracy more than 30% lower than noncancer controls.
Conclusions
Existing cardiovascular risk scores have significantly worse predictive accuracy in cancer survivors compared with noncancer comparators, leading to an underestimation of risk in this cohort.
{"title":"Predictive Performance of Cardiovascular Risk Scores in Cancer Survivors From the UK Biobank","authors":"Celeste McCracken MSc , Dorina-Gabriela Condurache MBBS , Liliana Szabo MBBS, PhD , Hussein Elghazaly MBBS , Fiona M. Walter MA, MD , Adam J. Mead MBBS, PhD , Ronjon Chakraverty MBBS, PhD , Nicholas C. Harvey MB BChir, PhD , Charlotte H. Manisty MBBS, PhD , Steffen E. Petersen MSc, MPH, MD, DPhil , Stefan Neubauer MBBS , Zahra Raisi-Estabragh MBChB, PhD","doi":"10.1016/j.jaccao.2024.05.015","DOIUrl":"10.1016/j.jaccao.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><p>Cardiovascular preventive strategies are guided by risk scores with unknown validity in cancer cohorts.</p></div><div><h3>Objectives</h3><p>This study aimed to evaluate the predictive performance of 7 established cardiovascular risk scores in cancer survivors from the UK Biobank.</p></div><div><h3>Methods</h3><p>The predictive performance of QRISK3, Systematic Coronary Risk Evaluation 2 (SCORE2)/Systematic Coronary Risk Evaluation for Older Persons (SCORE-OP), Framingham Risk Score, Pooled Cohort equations to Prevent Heart Failure (PCP-HF), CHARGE-AF, QStroke, and CHA<sub>2</sub>DS<sub>2</sub>-VASc was calculated in participants with and without a history of cancer. Participants were propensity matched on age, sex, deprivation, health behaviors, family history, and metabolic conditions. Analyses were stratified into any cancer, breast, lung, prostate, brain/central nervous system, hematologic malignancies, Hodgkin lymphoma, and non-Hodgkin lymphoma. Incident cardiovascular events were tracked through health record linkage over 10 years of follow-up. The area under the receiver operating curve, balanced accuracy, and sensitivity were reported.</p></div><div><h3>Results</h3><p>The analysis included 31,534 cancer survivors and 126,136 covariate-matched controls. Risk score distributions were near identical in cases and controls. Participants with any cancer had a significantly higher incidence of all cardiovascular outcomes than matched controls. Performance metrics were significantly worse for all risk scores in cancer cases than in matched controls. The most notable differences were among participants with a history of hematologic malignancies who had significantly higher outcome rates and poorer risk score performance than their matched controls. The performance of risk scores for predicting stroke in participants with brain/central nervous system cancer was very poor, with predictive accuracy more than 30% lower than noncancer controls.</p></div><div><h3>Conclusions</h3><p>Existing cardiovascular risk scores have significantly worse predictive accuracy in cancer survivors compared with noncancer comparators, leading to an underestimation of risk in this cohort.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 4","pages":"Pages 575-588"},"PeriodicalIF":12.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324002151/pdfft?md5=a3698cdfec1ed81262f719f95426233e&pid=1-s2.0-S2666087324002151-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jaccao.2024.05.009
Gerard M. Walls MB BCh, PhD , Nicola Hill MB BCh , Michael McMahon MB BCh , Brian óg Kearney MB BCh , Conor McCann MB BCh , Peter McKavanagh MB BCh, PhD , Valentina Giacometti PhD , Aidan J. Cole MB BCh, PhD , Suneil Jain MB BCh, PhD , Conor K. McGarry PhD , Karl Butterworth PhD , Jonathan McAleese MB BCh, MA , Mark Harbinson MB BCh, MD , Gerard G. Hanna MB BCh, PhD
Background
Radiation-induced cardiotoxicity poses a significant challenge in lung cancer management because of the close anatomical proximity of the heart to the lungs, compounded by a high prevalence of cardiovascular risk factors among patients.
Objectives
The aim of this study was to assess the predictive value of routinely available clinical and imaging-based cardiac parameters in identifying “high risk” patients for major adverse cardiac events (MACE) and mortality following radiation therapy (RT).
Methods
The medical records of patients who underwent definitive RT for non–small cell lung cancer using modern planning techniques at a single center between 2015 and 2020 were retrospectively reviewed. Cardiac events were verified by cardiologists, and mortality data were confirmed with the national registry. Cardiac substructures were autosegmented on RT planning scans for retrospective structure and dose analysis, and their correlation with clinical factors was examined. Fine-Gray models were used to analyze relationships while considering the competing risk for death.
Results
Among 478 patients included in the study, 77 (16%) developed 88 MACE, with a median time to event of 16.3 months. A higher burden of pre-existing cardiac diseases was associated with an increased cumulative incidence of MACE (55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; P < 0.001). Left atrial and left ventricular enlargement on RT planning scans was associated with cumulative incidence of atrial arrhythmia (14% [95% CI: 9%-20%] vs 4% [95% CI: 2%-8%]; P = 0.001) and heart failure (13% [95% CI: 8%-18%] vs 6% [95% CI: 3%-10%]; P = 0.007) at 5 years, respectively. However, myocardial infarction was not associated with the presence of coronary calcium (4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]; P = 0.094). No cardiac imaging metrics were found to be both clinically and statistically associated with survival.
Conclusions
The present findings suggest that cardiac history and RT planning scan parameters may offer potential utility in prospectively evaluating cardiotoxicity risk following RT for patients with lung cancer.
{"title":"Baseline Cardiac Parameters as Biomarkers of Radiation Cardiotoxicity in Lung Cancer","authors":"Gerard M. Walls MB BCh, PhD , Nicola Hill MB BCh , Michael McMahon MB BCh , Brian óg Kearney MB BCh , Conor McCann MB BCh , Peter McKavanagh MB BCh, PhD , Valentina Giacometti PhD , Aidan J. Cole MB BCh, PhD , Suneil Jain MB BCh, PhD , Conor K. McGarry PhD , Karl Butterworth PhD , Jonathan McAleese MB BCh, MA , Mark Harbinson MB BCh, MD , Gerard G. Hanna MB BCh, PhD","doi":"10.1016/j.jaccao.2024.05.009","DOIUrl":"10.1016/j.jaccao.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><p>Radiation-induced cardiotoxicity poses a significant challenge in lung cancer management because of the close anatomical proximity of the heart to the lungs, compounded by a high prevalence of cardiovascular risk factors among patients.</p></div><div><h3>Objectives</h3><p>The aim of this study was to assess the predictive value of routinely available clinical and imaging-based cardiac parameters in identifying “high risk” patients for major adverse cardiac events (MACE) and mortality following radiation therapy (RT).</p></div><div><h3>Methods</h3><p>The medical records of patients who underwent definitive RT for non–small cell lung cancer using modern planning techniques at a single center between 2015 and 2020 were retrospectively reviewed. Cardiac events were verified by cardiologists, and mortality data were confirmed with the national registry. Cardiac substructures were autosegmented on RT planning scans for retrospective structure and dose analysis, and their correlation with clinical factors was examined. Fine-Gray models were used to analyze relationships while considering the competing risk for death.</p></div><div><h3>Results</h3><p>Among 478 patients included in the study, 77 (16%) developed 88 MACE, with a median time to event of 16.3 months. A higher burden of pre-existing cardiac diseases was associated with an increased cumulative incidence of MACE (55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; <em>P</em> < 0.001). Left atrial and left ventricular enlargement on RT planning scans was associated with cumulative incidence of atrial arrhythmia (14% [95% CI: 9%-20%] vs 4% [95% CI: 2%-8%]; <em>P</em> = 0.001) and heart failure (13% [95% CI: 8%-18%] vs 6% [95% CI: 3%-10%]; <em>P</em> = 0.007) at 5 years, respectively. However, myocardial infarction was not associated with the presence of coronary calcium (4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]; <em>P</em> = 0.094). No cardiac imaging metrics were found to be both clinically and statistically associated with survival.</p></div><div><h3>Conclusions</h3><p>The present findings suggest that cardiac history and RT planning scan parameters may offer potential utility in prospectively evaluating cardiotoxicity risk following RT for patients with lung cancer.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 4","pages":"Pages 529-540"},"PeriodicalIF":12.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324001972/pdfft?md5=2cfea7dc836ba7f66911832f2566e9bf&pid=1-s2.0-S2666087324001972-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jaccao.2024.03.007
Ronald Witteles MD , John L. Jefferies MD, MPH , Suraj Kapa MD , Francesco Cappelli MD, PhD , Marla B. Sultan MD, MBA , Balarama Gundapaneni MS , Margot K. Davis MD, MS , Pablo Garcia-Pavia MD
Background
Atrial fibrillation/atrial flutter (AF/AFL) are common manifestations of transthyretin amyloid cardiomyopathy (ATTR-CM) but have not been found to be predictive of mortality.
Objectives
This analysis aimed to examine whether baseline or historical AF/AFL at enrollment was prognostic for all-cause mortality.
Methods
In the ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial), a 30-month study of tafamidis vs placebo for ATTR-CM, AF/AFL was evaluated as an independent prognostic factor for all-cause mortality using Cox proportional hazards modelling. The impact of AF/AFL on tafamidis efficacy was explored by adding an interaction term for AF/AFL status and treatment.
Results
ATTR-ACT enrolled 441 patients with ATTR-CM (median age 75 years; 90% male); 314 (71.2%) had baseline or historical AF/AFL at enrollment. AF/AFL was an independent prognostic factor for all-cause mortality after adjusting for covariates prespecified in the ATTR-ACT model (treatment, genotype, New York Heart Association functional class; HR: 0.550; 95% CI: 0.368-0.821) but not in an expanded stepwise model selection analysis including 23 covariates (blood urea nitrogen and N-terminal pro–B-type natriuretic peptide concentration, 6-minute walk test distance, genotype, treatment, and global longitudinal strain were prognostic [P < 0.01]). The interactions between tafamidis treatment and AF/AFL for all-cause mortality (P = 0.33) and changes in Kansas City Cardiomyopathy Questionnaire Overall Summary score (P = 0.83) and 6-minute walk test distance (P = 0.82) were not significant.
Conclusions
In ATTR-ACT, baseline or historical AF/AFL was prognostic for all-cause mortality in analyses with limited adjustment but not after accounting for additional indicators of disease severity. Baseline or historical AF/AFL did not impact the efficacy of tafamidis treatment. (Safety and Efficacy of Tafamidis in Patients With Transthyretin Cardiomyopathy [ATTR-ACT]; NCT01994889)
背景心房颤动/心房扑动（AF/AFL）是转甲状腺素淀粉样变性心肌病（ATTR-CM）的常见表现，但尚未发现其可预测死亡率。方法在为期 30 个月的 ATTR-ACT（Tafamidis in Transthyretin Cardiomyopathy Clinical Trial）研究中，使用 Cox 比例危险模型评估了 AF/AFL 作为全因死亡率的独立预后因素。结果ATTR-ACT共招募了441名ATTR-CM患者（中位年龄75岁；90%为男性），其中314人（71.2%）在入组时存在基线或历史性房颤/AFL。在调整 ATTR-ACT 模型中预设的协变量（治疗、基因型、纽约心脏协会功能分级；HR：0.550；95% CI：0.368-0.821）后，心房颤动/心房颤动是全因死亡率的独立预后因素，但在扩展模型中并非如此。HR：0.550；95 CI：0.368-0.821），但在包括 23 个协变量（血尿素氮和 N 末端前 B 型钠尿肽浓度、6 分钟步行测试距离、基因型、治疗和全局纵向应变）的扩展逐步模型选择分析中则不具有预后意义 [P<；0.01]）。结论在ATTR-ACT中，基线或历史房颤/AFL在有限调整的分析中是全因死亡率的预后因素，但在考虑了疾病严重程度的其他指标后则不是。基线或既往房颤/AFL对他法米迪的疗效没有影响。(塔法米地斯治疗转甲状腺素心肌病患者的安全性和疗效[ATTR-ACT]；NCT01994889）。
{"title":"Atrial Fibrillation as a Prognostic Factor for All-Cause Mortality in Patients With Transthyretin Amyloid Cardiomyopathy","authors":"Ronald Witteles MD , John L. Jefferies MD, MPH , Suraj Kapa MD , Francesco Cappelli MD, PhD , Marla B. Sultan MD, MBA , Balarama Gundapaneni MS , Margot K. Davis MD, MS , Pablo Garcia-Pavia MD","doi":"10.1016/j.jaccao.2024.03.007","DOIUrl":"10.1016/j.jaccao.2024.03.007","url":null,"abstract":"<div><h3>Background</h3><p>Atrial fibrillation/atrial flutter (AF/AFL) are common manifestations of transthyretin amyloid cardiomyopathy (ATTR-CM) but have not been found to be predictive of mortality.</p></div><div><h3>Objectives</h3><p>This analysis aimed to examine whether baseline or historical AF/AFL at enrollment was prognostic for all-cause mortality.</p></div><div><h3>Methods</h3><p>In the ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial), a 30-month study of tafamidis vs placebo for ATTR-CM, AF/AFL was evaluated as an independent prognostic factor for all-cause mortality using Cox proportional hazards modelling. The impact of AF/AFL on tafamidis efficacy was explored by adding an interaction term for AF/AFL status and treatment.</p></div><div><h3>Results</h3><p>ATTR-ACT enrolled 441 patients with ATTR-CM (median age 75 years; 90% male); 314 (71.2%) had baseline or historical AF/AFL at enrollment. AF/AFL was an independent prognostic factor for all-cause mortality after adjusting for covariates prespecified in the ATTR-ACT model (treatment, genotype, New York Heart Association functional class; HR: 0.550; 95% CI: 0.368-0.821) but not in an expanded stepwise model selection analysis including 23 covariates (blood urea nitrogen and N-terminal pro–B-type natriuretic peptide concentration, 6-minute walk test distance, genotype, treatment, and global longitudinal strain were prognostic [<em>P</em> < 0.01]). The interactions between tafamidis treatment and AF/AFL for all-cause mortality (<em>P</em> = 0.33) and changes in Kansas City Cardiomyopathy Questionnaire Overall Summary score (<em>P</em> = 0.83) and 6-minute walk test distance (<em>P</em> = 0.82) were not significant.</p></div><div><h3>Conclusions</h3><p>In ATTR-ACT, baseline or historical AF/AFL was prognostic for all-cause mortality in analyses with limited adjustment but not after accounting for additional indicators of disease severity. Baseline or historical AF/AFL did not impact the efficacy of tafamidis treatment. (Safety and Efficacy of Tafamidis in Patients With Transthyretin Cardiomyopathy [ATTR-ACT]; <span><span>NCT01994889</span><svg><path></path></svg></span>)</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 4","pages":"Pages 592-598"},"PeriodicalIF":12.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266608732400139X/pdfft?md5=2bcd89bda9a88b279326659fce90ee15&pid=1-s2.0-S266608732400139X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号