High incidence of thromboembolic events in immunoglobulin light chain amyloidosis (AL) and transthyretin amyloidosis (TTR) cardiomyopathy: data from institutional registry.

DIEGO PEREZ DE ARENAZA; ET AL; MARIA LOURDES POSADAS MARTINEZ

Congreso; ESC Congress 2023; 2023

ESC Congress 2023Doctor Diego Perez de Arenaza (EUD ID : 106701)Hospital Italiano De Buenos AiresGascon 4501181 - Buenos Aires ArgentinaPhone : +54 54 11 4959 0200 - Fax : +54 54 11 4958 2623Email : diego.perezdearenaza@hospitalitaliano.org.arTitle : High incidence of thromboembolic events in immunoglobulin light chain amyloidosis (AL) and transthyretin amyloidosis (TTR)cardiomyopathy: data from institutional registry.Topic : 22.6.7 - Infiltrative Myocardial DiseaseCategory: BedsideOption : Young Investigator Award (YIA) Clinical CardiologyFunding Acknowledgements : - Type of funding sources: Private hospital(s) - Cardiology department - I agree that this information can beanonymised and then used for statistical purposes onlyE. Villanueva1, S. De Cotto1, A. Aguirre1, E. Nucifora1, E. Rossi1, I. Bluro1, L. Posadas Martinez1, R. Pizarro1, D. Perez De Arenaza1 - (1) ItalianHospital of Buenos Aires, Buenos Aires, ArgentinaEarly higher incidence of death and thromboembolic events in immunoglobulin light chain amyloidosis (AL) compared totransthyretin amyloidosis (TTR) cardiomyopathy: data from institutional registry.AimsPatients with cardiac amyloidosis have poor outcomes due to the development of heart failure, atrial-arrhythmia and thepulmonary or systemic thromboembolic events. High prevalence of thrombus in amyloidosis was reported (1) but not higherincidence of thromboembolic events stratified by amyloidosis type. The aim of this study was to evaluate the difference ofincidence of death or thromboembolic events between light-chain type (AL) and transthyretin amyloidosis (ATTR) with cardiacinvolvement.Methods and ResultsThis was a retrospective cohort of patients with amyloidosis AL and TTR included in the Institutional Registry of Amyloidosis(ClinicalTrials.gov NCT01347047). All patients were followed to the thrombo-embolic event defined as ischemic stroke,transient ischemic-attack (TIA), splenic or peripheral ischemia, deep vein thrombosis and pulmonary embolism. All patients havecardiac involvement by systemic amyloidosis. The follow up was censored at two years follow up. If there is strong evidence thatthe hazard rates in the two groups of amyloidosis (AL vs TTR) are not proportional, we model time dependent effects using theCox model splitting the time scale to obtain piecewise HRs. In the analysis, the hazard rates were not proportional over the followup period (figure 1). Therefore, we splited the time scale and a separate HR ccould be estimated within each time intervalpreviously defined (three-time scale periods were obtained, the first 6 months, from 6 to 12 months, and 12 to 24months).Overall, 201 patients were included in this study, 54.2% (n=109) with AL and 45,8% (n=92) with ATTR amyloidosis. The deathrate was 24,6 % (n=50), the embolic event rate 9.45% (n=19), and the combined endpoint of death or embolic event was 30%(n=60%) at two years. The rate of death or embolic event in the first time scale HR was higher in AL patients compared ATTRpatients (HR 2.70 , CI 1.049 - 6.97, p=0,039) but similar in the second time scale periods (HR 0,81, CI 0.28 2.63, p=0.807) andthird time scale periods (HR 0,55, CI 0.19 - 1.53, p=0.255).Conclusions:In patients with AL there was an early higher risk of death and thromboembolic events compared to ATTR amyloidosis. The highrisk was not observed in AL patients with longer survival and follow up. These findings highlight the higher early incidence ofthromboembolic events in AL patients that might lead to close monitoring and low threshold for anticoagulant treatment inselected patients.