Significant tricuspid regurgitation is associated with adverse outcomes in patients with transthyretin amyloidosis

AGUIRRE, MARÍA ADELA; ROSSI, EMILIANO; PEREZ DE ARENAZA, DIEGO; VILLANUEVA, EUGENIA; DECOTTO, SANTIAGO; IROULART, JUAN; POSADAS MARTÍNEZ, MARÍA LOURDES; ROVEDA, GUIDO; NUCIFORA, ELSA MERCEDES

HEIDELBERG

Simposio; XVIII International Symposium on Amyloidosis - ISA 2022; 2022

INTERNATIONAL SOCIETY OF AMYLOIDOSIS

Significant tricuspid regurgitation is associated with adverse outcomes in patients withtransthyretin amyloidosis.IntroductionPatients with transthyretin amyloidosis (ATTR) have poor outcomes due to the development ofheart failure. Tricuspid regurgitation (TR) is associated with adverse outcomes in patients withheart failure.PurposeThe purpose of this study was to evaluate if the presence of significantTR is associated withadverse cardiac outcomes (death or hospitalization for heart failure) in patients with ATTR andcardiac involvement.MethodsThis was a retrospective cohort of patients with amyloidosis ATTR included in the InstitutionalRegistry of Amyloidosis (ClinicalTrials.gov NCT01347047). All patients have cardiac ATTRinvolvement in the echocardiogram and evaluation of right ventricle chamber for tricuspidregurgitation. Cardiac involvement was defined as uptake on pyrophosphate scintigraphy ortypical involvement on cardiac magnetic resonance.Significant TR was defined as moderate or severe regurgitation according to qualitative andquantitative measurements.A two years follow up was performed in this cohort to assess the incidence of the compositeoutcome of death and hospitalization for heart failure.ResultsOverall, 93 ATTR patients were included in the study. 5 were variant transthyretin (ATTRv). Themean age at diagnosis was 82,5 years [IQR 75 -86]. 86 % were male, and the mean leftventricular ejection fraction was 52 % [IQR 43 - 60]. 32,2 % (n=30) had significant TR. Patientswith significant TR had similar age (79,9 vs 81,6 p=0,3), higher pro-BNP values (6327 vs 3711p=0,004), and lower left ventricular ejection fraction compared to patients without significantregurgitation. In the univariate analysis, the incidence of composite death or heart failure washigher in patients with significant TR compared to patients without significant TR. In a Coxregression multivariate analysis, only pro-BNP (HR 1.00, 95% CI 1.00005- 1.0002, p=0.001), andsignificant TR (HR 2.23, 95% CI 1.12- 4.42, p=0.021), were associated with the composite deathor hospitalization for heart failure.ConclusionPatients with ATTR and significant TR have worse outcomes compared to patients withoutsignificant TR. These findings, might support to explore further research for interventions thatreduce severity of the tricuspid regurgitation in patients with ATTR and heart failure.