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Outcome and incidence of appropriate implantable cardioverter-defibrillator therapy in patients with cardiac amyloidosis
- Source :
- International journal of cardiology. 222
- Publication Year :
- 2016
-
Abstract
- Background Cardiac amyloidosis (CA) is associated with a poor prognosis with the proposed mechanism of sudden cardiac death in the majority of patients being pulseless electrical activity. However, the incidence of ventricular arrhythmias (VA) and implantable cardioverter-defibrillator (ICD) indications in CA patients are unclear. We performed a detailed evaluation of our CA population undergoing ICD implantation and assessed appropriate ICD therapy and survival predictors. Methods We included consecutive patients from June 2008 to November 2014 in five centers. ICDs were systematically interrogated and clinical data recorded during follow-up. Results Forty-five patients (35 males, mean age 66±12years) with CA who underwent ICD implantation (84.4% primary prevention) were included. CA types were hereditary transthyretin in 27 patients (60%), light chain (AL) in 12 (27%) and senile in 6 (13%). After a mean follow-up of 17±14months, 12 patients (27%) had at least 1 appropriate ICD therapy occurring after 4.7±6.6months. Patients with or without ICD therapy had no significant differences in baseline characteristics, amyloidosis type, LVEF, and type of prevention although there was a trend towards a better 2D global longitudinal strain in patients with ICD therapy ( P =0.08). Over the follow-up, 12 patients died (27%) and 6 underwent cardiac transplantation (13%). From multivariate analysis a worse prognosis was associated with higher NT-proBNP level (>6800pg/mL, HR=5.5[1.7–17.8]) and AL type (HR=4.9[1.5–16.3]). Conclusions Appropriate ICD therapies are common (27%) in CA patients. No specific strong VA predictor could be identified. However, patients with advanced heart disease, especially with AL-CA, display a poorer outcome.
- Subjects :
- Male
medicine.medical_specialty
Heart Diseases
medicine.medical_treatment
Population
030204 cardiovascular system & hematology
Sudden cardiac death
03 medical and health sciences
Electrocardiography
0302 clinical medicine
Internal medicine
medicine
Humans
030212 general & internal medicine
education
Aged
education.field_of_study
Ejection fraction
business.industry
Amyloidosis
Incidence
Middle Aged
medicine.disease
Implantable cardioverter-defibrillator
Defibrillators, Implantable
Transplantation
Treatment Outcome
Cardiac amyloidosis
Pulseless electrical activity
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 18741754
- Volume :
- 222
- Database :
- OpenAIRE
- Journal :
- International journal of cardiology
- Accession number :
- edsair.doi.dedup.....9e04a337e21ce6da905b00366d09b556