Estimating nuclear scanning capacity requirements for patients with suspected cardiac transthyretin amyloidosis

• Published in: ESC Heart Failure Vol. 10; no. 2; pp. 1492 - 1496
• Main Authors: Leo, Vincenzo C., Kazmi, Syed, Brownrigg, Jack, Araghi, Marzieh, Sarna, Harpreet S., Pellicori, Pierpaolo, Cuthbert, Joe, Cleland, John G.F., Clark, Andrew L.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.04.2023; John Wiley and Sons Inc; Wiley
• Subjects: Amyloid Neuropathies, Familial - diagnosis; Amyloidosis; Blood pressure; Body mass index; Chronic obstructive pulmonary disease; Diabetes; Diuretics; Ejection fraction; Heart; Heart failure; Heart rate; Humans; Hypertension; Letter to the Editor; Letters to the Editor; Peptides; Scintigraphy; Velocity
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.14315

For the present analysis, we focused only on patients with HF who had at their initial visit (i) a diagnosis of HF, based on symptoms and signs together with a raised N-terminal pro-brain natriuretic peptide (NT-proBNP) (≥400 ng/L) 4; (ii) LVEF ≥45%, corresponding to mild or no evidence of LVSD, as determined by echocardiography; and (iii) measurements of LVWT. HF, heart failure; LVEF, left ventricular ejection fraction; LVWT, left ventricular wall thickness; NT-proBNP, N-terminal pro-brain natriuretic peptide; SBP, systolic blood pressure. <14 mm) Age at referral (years) 78 (72, 83) 78 (72, 83) 0.54 77 (72, 82) 78 (72, 83) 0.03 Male (%) 56 45 <0.0001 59 49 0.004 BMI (kg/m2) 28 (25, 33) 27 (24, 31) 0.003 28 (25, 32) 28 (24, 32) 0.11 SBP (mmHg) 148 (130, 167) 142 (126, 163) 0.001 148 (130, 171) 145 (128, 163) 0.057 SBP < 140 mmHg (%) 38 45 0.004 39 42 0.34 DBP (mmHg) 79 (69, 89) 77 (68, 89) 0.17 79 (69, 90) 78 (68, 89) 0.59 HR (BPM) 71 (60, 84) 72 (62, 84) 0.26 69 (60, 81) 72 (61, 84) 0.89 NYHA class III/IV 32 31 0.85 29 32 0.54 6MWT (m) 288 (120, 375) 300 (135, 360) 0.88 300 (147, 375) 288 (120, 375) 0.41 ECG Heart rate (bpm) 71 (60, 84) 72 (62, 84) 0.26 69 (60, 81) 71 (61, 8) 0.08 PR interval (ms) 172 (154, 198) 168 (151, 194) 0.04 169 (154, 202) 170 (152, 196) 0.63 QRS duration (ms) 98 (88, 116) 92 (84, 108) <0.0001 100 (88, 119) 94 (84, 110) 0.0001 NT-proBNP (ng/L) 1386 (778, 2558) 1244 (776, 2256) 0.02 1497 (811, 2675) 1286 (773, 2325) 0.04 Co-morbidities AF (%) 44 48 0.13 41 47 0.08 IHD (%) 33 34 0.44 37 33 0.27 History of hypertension (%) 52 44 0.002 55 48 0.02 Diabetes (%) 27 22 0.04 32 24 0.005 COPD (%) 8 9 0.20 8 9 0.64 Treatment at referral Loop diuretics (%) 72 65 0.002 71 68 0.26 Thiazide diuretics (%) 8 8 0.93 7 8 0.63 ACEi/ARB (%) 63 61 0.44 61 63 0.68 Beta blockers (%) 56 61 0.03 51 60 0.007 MRA (%) 12 10 0.16 12 11 0.46 Echocardiography LVEF (%) 54 (48, 60) 55 (49, 60) 0.39 53 (47, 59) 55 (49, 61) 0.06 LVEDD (cm, BSA indexed) 2.5 (2.2, 2.8) 2.6 (2.3, 2.9) <0.0001 2.5 (2.2, 2.8) 2.6 (2.3, 2.9) 0.001 LVESD (cm, BSA indexed) 1.7 (1.5, 2.0) 1.8 (1.6, 2.1) <0.01 1.8 (1.5, 2.1) 1.8 (1.5, 2.1) 0.35 LA diameter (cm, BSA indexed) 2.2 (1.8, 2.5) 2.1 (1.9, 2.4) 0.31 2.2 (1.9, 2.6) 2.2 (1.9, 2.4) 0.08 Any mitral regurgitation (%) 68 73 0.03 70 71 0.76 Mitral regurgitation >moderate (%) 10 11 0.75 12 10 0.33 Aortic root (cm) 3.3 (3.0, 3.6) 3.2 (2.9, 3.5) <0.001 3.3 (3.0, 3.6) 3.2 (2.9, 3.6) 0.25 Aortic velocity (m/s) 1.4 (1.1, 1.8) 1.3 (1.1, 1.6) <0.0001 1.4 (1.1, 1.8) 1.4 (1.1, 1.7) 0.24 Aortic velocity, <3 m/s (%) 94 96 94 95 Aortic velocity, 3–4 m/s (%) 4 2 0.02 4 3 0.47 Aortic velocity, >4 m/s (%) 2 1 2 1 Any aortic regurgitation (%) 34 33 0.68 34 33 0.75 Aortic regurgitation >moderate (%) 5 2 0.01 4 3 0.56 Continuous variables were analysed using a Mann–Whitney analysis and reported as median with 25th and 75th centiles. Categorical variables were analysed using Fisher's exact test and reported as percentages. 6MWT, 6-min walk test; ACEi, angiotensin-converting enzyme inhibitors; AF, atrial fibrillation; ARB, angiotensin receptor blockers; BMI, body mass index; BPM, beats per minute; BPM, beats per minute; BSA, body surface area; COPD, chronic obstructive pulmonary disease; DBP, diastolic blood pressure; HR, heart rate; IHD, ischaemic heart disease; LA, left atrial; LVEDD, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; LVSD, left ventricular systolic dysfunction; MRA, mineral corticoid receptor antagonist; NT-proBNP, N-terminal pro-brain natriuretic peptide; NYHA, New York Heart Failure Association; SBP, systolic blood pressure.