Tafamidis and Incidence of Atrial Fibrillation in Transthyretin Amyloid Cardiomyopathy.
Tafamidis and Incidence of Atrial Fibrillation in Transthyretin Amyloid Cardiomyopathy.
复制标题
Tafamidis 与运甲状腺素蛋白淀粉样心肌病中心房颤动的发生率。
DOI：
10.1016/j.jacep.2022.11.005
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Yarmohammadi,Hirad
中科院分区：
文献类型：
--
作者：
Girvin,ZacharyP;Sweat,AustinO;Kochav,StephanieM;Maurer,MathewS;Dizon,Jose;Wan,ElaineY;Biviano,Angelo;Garan,Hasan;Yarmohammadi,Hirad
心房颤动 (AF) 是转甲状腺素蛋白淀粉样蛋白 (ATTR) 心肌病患者中最常见的持续性心律失常。 1 试验表明 ATTR 心肌病患者的全因死亡率、心脏病住院率和功能下降有所降低。 2 然而，其对 AF 发生率的影响却很少被研究。我们对 2008 年至 2019 年间在哥伦比亚大学欧文医学中心接受心脏淀粉样变性治疗的 473 名患者进行了回顾性研究。通过检查患者的 12 导联心电图、心脏设备和动态心电图，证实患者存在 AF。事件 AF 定义为记录的持续时间至少 30 秒的 AF 事件。该方案得到了机构审查委员会的批准。在 473 名诊断为心脏淀粉样变性的患者中，129 名患者 (27%) 在诊断 ATTR 心肌病时尚未诊断为 AF。在这些患者中，36% 的患者确诊有基因突变，43% 的患者进行基因检测后未发现突变。该队列的平均年龄为 73.7+ 8.9 岁，大多数为男性 (87%)。平均左心室射血分数为 49%±16%，70 名（54%）患者需要抗凝治疗。总体而言，在 129 名无 AF 病史的患者中，43 名患者 (33%) 开始服用他法米迪。两组（服用tafamidis与不服用tafamidis）之间的既往史高血压（未接受tafamidis组为55% vs 服用tafamidis组为57%，P= 0.79）、肥胖症（13% vs 21%，P= 0.28）、糖尿病（19% vs 7%，P= 0.08）、冠状动脉疾病（26% vs 7%，P= 0.08）之间无统计学差异。 33%，P=0.46），或左心房直径（4.3 vs 4.6 厘米，P=0.13）。未接受他法米迪治疗的非裔美国患者数量较多（30% vs 12%，P = 0.02）。没有
Atrial fibrillation (AF) is the most common sustained arrhythmia seen in patients with transthyretin amyloid (ATTR) cardiomyopathy. 1 Trials have shown reductions in all-cause mortality, cardiac hospitalization, and functional decline in patients with ATTR cardiomyopathy. 2 However, its effect on incidence of AF is scarcely studied.We performed a retrospective review of 473 patients who were treated for cardiac amyloidosis at Columbia University Irving Medical Center between 2008 and 2019. The presence of AF in patients was confirmed by reviewing the patients’ 12-lead electrocardiograms, cardiac devices, and Holter monitors. Incident AF was defined as a recorded AF event of at least 30 seconds in duration. The protocol was approved by the Institutional Review Board. Of the 473 patients diagnosed with cardiac amyloidosis, 129 patients (27%) had not been diagnosed with AF at the time of diagnosis with ATTR cardiomyopathy. Of these patients, 36% had a confirmed genetic mutation and 43% had genetic testing without a mutation. Mean age of this cohort was 73.7+ 8.9 years, and the majority were male (87%). Average left ventricular ejection fraction was 49%+ 16%, and 70 (54%) patients required anticoagulation. Overall, of the 129 patients with no history of AF, 43 patients (33%) were started on tafamidis. There were no statistically significant differences between the 2 groups (taking tafamidis vs not taking tafamidis) in rates of prior history of hypertension (55% for those not receiving tafamidis vs 57% of those on tafamidis, P= 0.79), obesity (13% vs 21%, P= 0.28), diabetes mellitus (19% vs 7%, P= 0.08), coronary artery disease (26% vs 33%, P= 0.46), or left atrial diameter (4.3 vs 4.6 centimeters, P= 0.13). There was a larger number of African-American patients in the group not receiving tafamidis (30% vs 12%, P= 0.02). There was no