Prognostic and Added Value of Two-Dimensional Global Longitudinal Strain for Prediction of Survival in Patients with Light Chain Amyloidosis Undergoing Autologous Hematopoietic Cell Transplantation.
Prognostic and Added Value of Two-Dimensional Global Longitudinal Strain for Prediction of Survival in Patients with Light Chain Amyloidosis Undergoing Autologous Hematopoietic Cell Transplantation.
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DOI：
10.1016/j.echo.2017.08.017
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Liu JE
中科院分区：
文献类型：
--
作者：
Pun SC;Landau HJ;Riedel ER;Jordan J;Yu AF;Hassoun H;Chen CL;Steingart RM;Liu JE
在接受自体造血细胞移植（HCT）的轻链（AL）淀粉样蛋白患者中，评价1）基线总体纵向应变（GLS）的预后意义和2）GLS超出循环心脏生物标志物的风险分层附加值。Autumn HCT是延长AL淀粉样变性患者生存期的一线治疗。心脏受累是生存的最重要决定因素。然而，由于移植相关死亡率高风险和总生存率低，晚期心脏受累患者通常被排除在HCT之外。GLS是否可以提供额外的风险分层，并预测HCT后的生存率，在这一高风险人群仍不清楚。该研究纳入了82名新诊断的AL淀粉样变性患者，这些患者在2007年1月至2014年4月期间接受了前期HCT。在基线和HCT后12个月收集临床、超声心动图和血清心脏生物标志物数据。使用供应商独立的离线系统进行GLS测量。幸存者的中位随访时间为58个月。64%的患者处于基于生物标志物的马约II或III期。GLS、BNP、肌钙蛋白和二尖瓣E/A比值被确定为生存率的最强预测因子（p<0.0001）。其他预测因素包括性别、肌酐、游离轻链、室壁厚度和EF。马约分期与预后显著相关，I、II和III期患者的5年生存率分别为93%、72%和31%。17%的GLS被确定为最能区分存活者和非存活者的值，并且该临界值的应用提供了每个马约分期内的进一步死亡风险分层。GLS是接受HCT的AL淀粉样变性患者生存率的强预测因子，可能为风险分层提供超过血清心脏生物标志物的增量值。在评价HCT或其他试验性治疗的合格性时，GLS应与血清心脏生物标志物一起沿着作为标准参数。
To evaluate 1) the prognostic implication of baseline global longitudinal strain (GLS) and 2) the added value of GLS beyond the circulating cardiac biomarkers for risk stratification in patients with light chain (AL) amyloid undergoing autologous hematopoietic cell transplant (HCT). Autologous HCT is a first line therapy for prolonging survival in patients with AL amyloidosis. Cardiac involvement is the most important determinant of survival. However, patients with advanced cardiac involvement have often been excluded from HCT due to high risk of transplant related mortality and poor overall survival. Whether GLS can provide additional risk stratification and predict survival after HCT in this high risk population remains unclear. 82 patients with newly diagnosed AL amyloidosis who underwent upfront HCT between January 2007 to April 2014 were included in the study. Clinical, echo and serum cardiac biomarker data were collected at baseline and 12 months following HCT. GLS measurements were performed using a vendor independent offline system. The median follow-up time for survivors was 58 months. 64% of the patients were in biomarker based Mayo stage II or III. GLS, BNP, troponin and mitral E/A ratio were identified as the strongest predictors of survival (p<0.0001). Other predictors included sex, creatinine, free light chain, wall thickness and EF. The Mayo stage was significantly associated with outcome with 5 year survival of 93%, 72% and 31% in stage I, II and III patients, respectively. A GLS of 17% was identified as the value which best discriminated survivors from non-survivors and the application of this cutoff value provided further mortality risk stratification within each Mayo stage. GLS is a strong predictor of survival in patients with AL amyloidosis undergoing HCT, potentially providing incremental value over the serum cardiac biomarkers for risk stratification. GLS should be considered as a standard parameter along with the serum cardiac biomarkers when evaluating eligibility for HCT or other investigational therapies.
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DOI：
10.1016/s0735-1097(85)80475-7
发表时间：
1985-01-01
影响因子：
24
作者：
CUETOGARCIA, L;REEDER, GS;TAJIK, AJ
通讯作者：
TAJIK, AJ
影响因子：
5.7
作者：
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影响因子：
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作者：
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Miller, Fletcher A., Jr.
影响因子：
45.3
作者：
Gertz, Morie A.;Landau, Heather;Liedtke, Michaela
通讯作者：
Liedtke, Michaela
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
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