Diuretic Dose and NYHA Functional Class Are Independent Predictors of Mortality in Patients With Transthyretin Cardiac Amyloidosis.
Diuretic Dose and NYHA Functional Class Are Independent Predictors of Mortality in Patients With Transthyretin Cardiac Amyloidosis.
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利尿剂剂量和NYHA功能类别是经胸蛋白心脏淀粉样变性患者死亡率的独立预测指标。
DOI：
10.1016/j.jaccao.2020.06.007
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Maurer MS
中科院分区：
文献类型：
--
作者：
Cheng RK;Levy WC;Vasbinder A;Teruya S;De Los Santos J;Leedy D;Maurer MS
随着甲状腺素运载蛋白淀粉样变性心肌病（ATTR-CM）的诊断和治疗选择的增加，ATTR-CM患者的风险分层势在必行。我们假设利尿剂剂量和纽约心脏协会（NYHA）心功能分级是ATTR-CM患者死亡率的独立预测因子，并将逐渐增加现有风险评分。确定了转诊至单个中心的连续性ATTR-CM患者。校正后的考克斯比例风险模型确定了诊断时利尿剂剂量（呋塞米当量，mg/kg）与全因死亡率主要结局之间的相关性。评估在现有ATTR-CM风险评分基础上增加利尿剂剂量和NYHA心功能分级的增量值，以进行区分和校准。确定了309名患者，平均年龄73.2 ± 9.8岁，84.1%为男性，66%为野生型。每日平均利尿剂剂量为0.6 ± 1.0 mg/kg，与全因死亡率显著相关（未校正的风险比：每增加1 mg/kg为2.12，[95%置信区间：1.71至2.61]，完全校正的风险比：1.43 [95%置信区间：1.06至1.93]）。测试先前发表的ATTR风险评分，添加利尿剂剂量类别（0 mg/kg，>0至0.5 mg/kg，>0.5至1 mg/kg和>1至2 mg/kg），将马约风险评分的曲线下面积从0.693改善至0.767，英国风险评分从0.711改善至0.787，同时保留校准。增加NYHA心功能分级进一步改善了曲线下面积，分别为0.798和0.816。利尿剂剂量和NYHA心功能分级是ATTR-CM患者死亡率的独立预测因素，并为现有ATTR-CM风险评分提供增量值。
With increasing diagnoses and available treatment options for transthyretin amyloidosis cardiomyopathy (ATTR-CM), risk stratification of ATTR-CM patients is imperative. We hypothesized that diuretic dose and New York Heart Association (NYHA) functional class are independent predictors of mortality in ATTR-CM and would be incrementally additive to existent risk scores. Consecutive ATTR-CM patients referred to a single center were identified. Adjusted Cox proportional hazards models determined the association between diuretic dose (furosemide equivalent in mg/kg) at time of diagnosis and the primary outcome of all-cause mortality. The incremental value of adding diuretic dose and NYHA functional class to existing ATTR-CM risk scores was assessed for discrimination and calibration. 309 patients were identified, with mean age 73.2 ± 9.8 years, 84.1% male, and 66% wild type. Daily mean diuretic dose was 0.6 ± 1.0 mg/kg and significantly associated with all-cause mortality (unadjusted hazard ratio: 2.12 per 1-mg/kg increase, [95% confidence interval: 1.71 to 2.61] and fully adjusted hazard ratio: 1.43 [95% confidence interval: 1.06 to 1.93]). Testing previously published ATTR risk scores, adding diuretic dose as categories (0 mg/kg, >0 to 0.5 mg/kg, >0.5 to 1 mg/kg, and >1 to 2 mg/kg) improved the area under the curve of the Mayo risk score from 0.693 to 0.767 and the UK risk score from 0.711 to 0.787 while preserving calibration. Adding NYHA functional class further improved the area under the curve to 0.798 and 0.816, respectively. Diuretic dose and NYHA functional class are independent predictors of mortality in ATTR-CM patients and provide incremental value to existing ATTR-CM risk scores.
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作者：
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