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Left ventricular ejection time on echocardiography predicts long-term mortality in light chain amyloidosis. J Am Soc Echocardiogr 2009 Dec;22(12):1396-402 PMID: 19880277 PMCID: PMC2787973

Pubmed ID

19880277

Abstract

OBJECTIVE: Light chain amyloidosis (AL) is associated with high mortality. The aim was to identify echocardiographic parameters that predict AL long-term mortality.

METHODS: Forty-two subjects with biopsy-proven AL (43% were female; aged 61 +/- 12 years) underwent echocardiography and were followed 29 +/- 16 months (median 29.4 months). Standard echocardiographic and clinical parameters and heart failure (HF) class were tested using univariate/multivariable Cox proportional hazard regression analyses to identify markers of mortality.

RESULTS: Twenty-three subjects died, with a 1-year mortality of 44%. Univariate predictors of mortality were HF class (P < .001), left ventricular systolic ejection time (ET) (P = .002), alkaline phosphatase (P < .001), and aspartate and alanine aminotransferase (P = .003 each). On multivariable analysis, only HF class (hazard ratio [HR] 4.86; 95% confidence interval [CI], 1.58-14.9; P = .006), ET (10 ms increase; HR 0.87; CI, 0.78-0.97; P = .01), and alkaline phosphatase (10 U/L increase; HR 1.04; CI, 1.01-1.06; P = .01) were prognostic. ET <or= 240 ms had a sensitivity of 61% and a specificity of 90% in predicting 1-year mortality and a sensitivity of 73% and a specificity of 90% in predicting 1-year cardiac mortality.

CONCLUSION: AL amyloidosis was associated with high long-term mortality. Among echocardiographic and clinical parameters, only ET and alkaline phosphatase had incremental value to HF class in predicting mortality. This may be useful to identify high-risk patients.

Author List

Migrino RQ, Mareedu RK, Eastwood D, Bowers M, Harmann L, Hari P

Author

Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin

Scopus

2-s2.0-70450253173   23 Citations

MESH terms used to index this publication - Major topics in bold

Amyloidosis
Comorbidity
Echocardiography
Female
Germany
Humans
Immunoglobulin Light Chains
Longitudinal Studies
Male
Middle Aged
Prevalence
Reproducibility of Results
Risk Assessment
Risk Factors
Safety Management
Sensitivity and Specificity
Stroke Volume
Survival Analysis
Survival Rate
Ventricular Dysfunction, Left