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Background <p>Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is characterized by a labile equilibrium between preload and afterload. A tailored approach to supporting medical therapy based on noninvasive parameters able to describe the properties of both heart and systemic vasculature, and their interactions is required. However, data on ventriculo-arterial coupling (VAC) in ATTRwt-CM is lacking.</p> Objectives <p>To describe ventriculo-arterial coupling (VAC) and its clinical correlates in a contemporary cohort of patients with ATTRwt-CM.</p> Methods <p>The VAC, defined as the ratio between arterial (<i>E</i><sub><i>a</i></sub>) and ventricular elastance (<i>E</i><sub><i>es</i></sub>) was evaluated noninvasively using the single-beat algorithm based on arm cuff blood pressure, Doppler stroke volume, pre-ejection time and total ejection time.</p> Results <p>The study included 114 patients treated with the transthyretin stabilizer tafamidis from a national referral centre (median age 79&#xa0;years; 89% males). Median values were 1.48 (1.22–1.84) mmHg/ml for <i>E</i><sub><i>a</i></sub>, 1.86 (1.49–2.29) mmHg/ml for <i>E</i><sub><i>es</i></sub>, and 1.24 (0.96–1.58) for VAC. Patients with upper-tertile VAC showed worse clinical (National Amyloidosis Centre (NAC)/Mondor stage, <i>p</i> &lt; 0.001), laboratory (NT-pro-B-type natriuretic peptide levels, <i>p</i> &lt; 0.001), instrumental features (left ventricular ejection fraction and stroke volume, <i>p</i> = 0.0001 for both), and they received more intensive heart failure supportive therapies. The <i>E</i><sub><i>a</i></sub>/<i>E</i><sub><i>es</i></sub> ratio, but not its single components, was associated with NT-proBNP levels. Finally, the <i>E</i><sub><i>a</i></sub>/<i>E</i><sub><i>es</i></sub> ratio was an independent determinant of a high NAC/Mondor stage at both univariate (OR[95% CI]:15.39[3.51–67.35], <i>p</i> &lt; 0.001) and multivariate (OR[95% CI]:11.26[1.98–63.81], <i>p</i> = 0.006) logistic regression analyses.</p> Conclusion <p>In ATTRwt-CM patients, arterial and ventricular elastances and VAC are independent predictors of worse clinical status and more advanced disease stage.</p> Graphical Abstract <p></p>

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Left ventriculo-arterial coupling in a contemporary cohort of patients with wild-type transthyretin cardiac amyloidosis treated with tafamidis

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  • 发表日期：

    2025年11月3日

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  • Giuseppe Damiano Sanna,
  • Valeria Anna Di Simone,
  • Paolo Milani,
  • Alessandro Fogliani,
  • Roberta Mussinelli,
  • Gianluigi Guida,
  • Andrea Attanasio,
  • Laura Obici,
  • Marco Basset,
  • Martina Nanci,
  • Andrea Foli,
  • Gavino Casu,
  • Leonardo De Luca,
  • Mario Nuvolone,
  • Giampaolo Merlini,
  • Stefano Perlini,
  • Giovanni Palladini

摘要

Background

Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is characterized by a labile equilibrium between preload and afterload. A tailored approach to supporting medical therapy based on noninvasive parameters able to describe the properties of both heart and systemic vasculature, and their interactions is required. However, data on ventriculo-arterial coupling (VAC) in ATTRwt-CM is lacking.

Objectives

To describe ventriculo-arterial coupling (VAC) and its clinical correlates in a contemporary cohort of patients with ATTRwt-CM.

Methods

The VAC, defined as the ratio between arterial (Ea) and ventricular elastance (Ees) was evaluated noninvasively using the single-beat algorithm based on arm cuff blood pressure, Doppler stroke volume, pre-ejection time and total ejection time.

Results

The study included 114 patients treated with the transthyretin stabilizer tafamidis from a national referral centre (median age 79 years; 89% males). Median values were 1.48 (1.22–1.84) mmHg/ml for Ea, 1.86 (1.49–2.29) mmHg/ml for Ees, and 1.24 (0.96–1.58) for VAC. Patients with upper-tertile VAC showed worse clinical (National Amyloidosis Centre (NAC)/Mondor stage, p < 0.001), laboratory (NT-pro-B-type natriuretic peptide levels, p < 0.001), instrumental features (left ventricular ejection fraction and stroke volume, p = 0.0001 for both), and they received more intensive heart failure supportive therapies. The Ea/Ees ratio, but not its single components, was associated with NT-proBNP levels. Finally, the Ea/Ees ratio was an independent determinant of a high NAC/Mondor stage at both univariate (OR[95% CI]:15.39[3.51–67.35], p < 0.001) and multivariate (OR[95% CI]:11.26[1.98–63.81], p = 0.006) logistic regression analyses.

Conclusion

In ATTRwt-CM patients, arterial and ventricular elastances and VAC are independent predictors of worse clinical status and more advanced disease stage.

Graphical Abstract