Independent Prognostic Value of Stroke Volume Index in Patients With Immunoglobulin Light Chain Amyloidosis

Paolo Milani, Angela Dispenzieri, Christopher G Scott, Morie A Gertz, Stefano Perlini, Roberta Mussinelli, Martha Q Lacy, Francis K Buadi, Shaji Kumar, Mathew S Maurer, Giampaolo Merlini, Suzanne R Hayman, Nelson Leung, David Dingli, Kyle W Klarich, John A Lust, Yi Lin, Prashant Kapoor, Ronald S Go, Patricia A PellikkaYi L Hwa, Stephen R Zeldenrust, Robert A Kyle, S Vincent Rajkumar, Martha Grogan

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Heart involvement is the most important prognostic determinant in AL amyloidosis patients. Echocardiography is a cornerstone for the diagnosis and provides important prognostic information.

METHODS AND RESULTS: We studied 754 patients with AL amyloidosis who underwent echocardiographic assessment at the Mayo Clinic, including a Doppler-derived measurement of stroke volume (SV) within 30 days of their diagnosis to explore the prognostic role of echocardiographic variables in the context of a well-established soluble cardiac biomarker staging system. Reproducibility of SV, myocardial contraction fraction, and left ventricular strain was assessed in a separate, yet comparable, study cohort of 150 patients from the Pavia Amyloidosis Center. The echocardiographic measures most predictive for overall survival were SV index <33 mL/min, myocardial contraction fraction <34%, and cardiac index <2.4 L/min/m2 with respective hazard ratios (95% confidence intervals) of 2.95 (2.37-3.66), 2.36 (1.96-2.85), and 2.32 (1.91-2.80). For the subset that had left ventricular strain performed, the prognostic cut point was -14% (hazard ratios, 2.70; 95% confidence intervals, 1.84-3.96). Each parameter was independent of systolic blood pressure, Mayo staging system (NT-proBNP [N-terminal pro-B-type natriuretic peptide] and troponin), and ejection fraction on multivariable analysis. Simple predictive models for survival, including biomarker staging along with SV index or left ventricular strain, were generated.

CONCLUSIONS: SV index prognostic performance was similar to left ventricular strain in predicting survival in AL amyloidosis, independently of biomarker staging. Because SV index is routinely calculated and widely available, it could serve as the preferred echocardiographic measure to predict outcomes in AL amyloidosis patients.

Original languageEnglish
Pages (from-to)e006588
JournalCirculation. Cardiovascular imaging
Volume11
Issue number5
DOIs
Publication statusPublished - May 2018

Fingerprint

Immunoglobulin Light Chains
Amyloidosis
Stroke Volume
Myocardial Contraction
Biomarkers
Survival
Confidence Intervals
Blood Pressure
Troponin
Brain Natriuretic Peptide
Echocardiography
Cohort Studies

Cite this

Independent Prognostic Value of Stroke Volume Index in Patients With Immunoglobulin Light Chain Amyloidosis. / Milani, Paolo; Dispenzieri, Angela; Scott, Christopher G; Gertz, Morie A; Perlini, Stefano; Mussinelli, Roberta; Lacy, Martha Q; Buadi, Francis K; Kumar, Shaji; Maurer, Mathew S; Merlini, Giampaolo; Hayman, Suzanne R; Leung, Nelson; Dingli, David; Klarich, Kyle W; Lust, John A; Lin, Yi; Kapoor, Prashant; Go, Ronald S; Pellikka, Patricia A; Hwa, Yi L; Zeldenrust, Stephen R; Kyle, Robert A; Rajkumar, S Vincent; Grogan, Martha.

In: Circulation. Cardiovascular imaging, Vol. 11, No. 5, 05.2018, p. e006588.

Research output: Contribution to journalArticle

Milani, P, Dispenzieri, A, Scott, CG, Gertz, MA, Perlini, S, Mussinelli, R, Lacy, MQ, Buadi, FK, Kumar, S, Maurer, MS, Merlini, G, Hayman, SR, Leung, N, Dingli, D, Klarich, KW, Lust, JA, Lin, Y, Kapoor, P, Go, RS, Pellikka, PA, Hwa, YL, Zeldenrust, SR, Kyle, RA, Rajkumar, SV & Grogan, M 2018, 'Independent Prognostic Value of Stroke Volume Index in Patients With Immunoglobulin Light Chain Amyloidosis', Circulation. Cardiovascular imaging, vol. 11, no. 5, pp. e006588. https://doi.org/10.1161/CIRCIMAGING.117.006588
Milani, Paolo ; Dispenzieri, Angela ; Scott, Christopher G ; Gertz, Morie A ; Perlini, Stefano ; Mussinelli, Roberta ; Lacy, Martha Q ; Buadi, Francis K ; Kumar, Shaji ; Maurer, Mathew S ; Merlini, Giampaolo ; Hayman, Suzanne R ; Leung, Nelson ; Dingli, David ; Klarich, Kyle W ; Lust, John A ; Lin, Yi ; Kapoor, Prashant ; Go, Ronald S ; Pellikka, Patricia A ; Hwa, Yi L ; Zeldenrust, Stephen R ; Kyle, Robert A ; Rajkumar, S Vincent ; Grogan, Martha. / Independent Prognostic Value of Stroke Volume Index in Patients With Immunoglobulin Light Chain Amyloidosis. In: Circulation. Cardiovascular imaging. 2018 ; Vol. 11, No. 5. pp. e006588.
@article{5188b7151d8245248b6e044ada5b1ce9,
title = "Independent Prognostic Value of Stroke Volume Index in Patients With Immunoglobulin Light Chain Amyloidosis",
abstract = "BACKGROUND: Heart involvement is the most important prognostic determinant in AL amyloidosis patients. Echocardiography is a cornerstone for the diagnosis and provides important prognostic information.METHODS AND RESULTS: We studied 754 patients with AL amyloidosis who underwent echocardiographic assessment at the Mayo Clinic, including a Doppler-derived measurement of stroke volume (SV) within 30 days of their diagnosis to explore the prognostic role of echocardiographic variables in the context of a well-established soluble cardiac biomarker staging system. Reproducibility of SV, myocardial contraction fraction, and left ventricular strain was assessed in a separate, yet comparable, study cohort of 150 patients from the Pavia Amyloidosis Center. The echocardiographic measures most predictive for overall survival were SV index <33 mL/min, myocardial contraction fraction <34{\%}, and cardiac index <2.4 L/min/m2 with respective hazard ratios (95{\%} confidence intervals) of 2.95 (2.37-3.66), 2.36 (1.96-2.85), and 2.32 (1.91-2.80). For the subset that had left ventricular strain performed, the prognostic cut point was -14{\%} (hazard ratios, 2.70; 95{\%} confidence intervals, 1.84-3.96). Each parameter was independent of systolic blood pressure, Mayo staging system (NT-proBNP [N-terminal pro-B-type natriuretic peptide] and troponin), and ejection fraction on multivariable analysis. Simple predictive models for survival, including biomarker staging along with SV index or left ventricular strain, were generated.CONCLUSIONS: SV index prognostic performance was similar to left ventricular strain in predicting survival in AL amyloidosis, independently of biomarker staging. Because SV index is routinely calculated and widely available, it could serve as the preferred echocardiographic measure to predict outcomes in AL amyloidosis patients.",
author = "Paolo Milani and Angela Dispenzieri and Scott, {Christopher G} and Gertz, {Morie A} and Stefano Perlini and Roberta Mussinelli and Lacy, {Martha Q} and Buadi, {Francis K} and Shaji Kumar and Maurer, {Mathew S} and Giampaolo Merlini and Hayman, {Suzanne R} and Nelson Leung and David Dingli and Klarich, {Kyle W} and Lust, {John A} and Yi Lin and Prashant Kapoor and Go, {Ronald S} and Pellikka, {Patricia A} and Hwa, {Yi L} and Zeldenrust, {Stephen R} and Kyle, {Robert A} and Rajkumar, {S Vincent} and Martha Grogan",
note = "{\circledC} 2018 American Heart Association, Inc.",
year = "2018",
month = "5",
doi = "10.1161/CIRCIMAGING.117.006588",
language = "English",
volume = "11",
pages = "e006588",
journal = "Circulation: Cardiovascular Imaging",
issn = "1941-9651",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Independent Prognostic Value of Stroke Volume Index in Patients With Immunoglobulin Light Chain Amyloidosis

AU - Milani, Paolo

AU - Dispenzieri, Angela

AU - Scott, Christopher G

AU - Gertz, Morie A

AU - Perlini, Stefano

AU - Mussinelli, Roberta

AU - Lacy, Martha Q

AU - Buadi, Francis K

AU - Kumar, Shaji

AU - Maurer, Mathew S

AU - Merlini, Giampaolo

AU - Hayman, Suzanne R

AU - Leung, Nelson

AU - Dingli, David

AU - Klarich, Kyle W

AU - Lust, John A

AU - Lin, Yi

AU - Kapoor, Prashant

AU - Go, Ronald S

AU - Pellikka, Patricia A

AU - Hwa, Yi L

AU - Zeldenrust, Stephen R

AU - Kyle, Robert A

AU - Rajkumar, S Vincent

AU - Grogan, Martha

N1 - © 2018 American Heart Association, Inc.

PY - 2018/5

Y1 - 2018/5

N2 - BACKGROUND: Heart involvement is the most important prognostic determinant in AL amyloidosis patients. Echocardiography is a cornerstone for the diagnosis and provides important prognostic information.METHODS AND RESULTS: We studied 754 patients with AL amyloidosis who underwent echocardiographic assessment at the Mayo Clinic, including a Doppler-derived measurement of stroke volume (SV) within 30 days of their diagnosis to explore the prognostic role of echocardiographic variables in the context of a well-established soluble cardiac biomarker staging system. Reproducibility of SV, myocardial contraction fraction, and left ventricular strain was assessed in a separate, yet comparable, study cohort of 150 patients from the Pavia Amyloidosis Center. The echocardiographic measures most predictive for overall survival were SV index <33 mL/min, myocardial contraction fraction <34%, and cardiac index <2.4 L/min/m2 with respective hazard ratios (95% confidence intervals) of 2.95 (2.37-3.66), 2.36 (1.96-2.85), and 2.32 (1.91-2.80). For the subset that had left ventricular strain performed, the prognostic cut point was -14% (hazard ratios, 2.70; 95% confidence intervals, 1.84-3.96). Each parameter was independent of systolic blood pressure, Mayo staging system (NT-proBNP [N-terminal pro-B-type natriuretic peptide] and troponin), and ejection fraction on multivariable analysis. Simple predictive models for survival, including biomarker staging along with SV index or left ventricular strain, were generated.CONCLUSIONS: SV index prognostic performance was similar to left ventricular strain in predicting survival in AL amyloidosis, independently of biomarker staging. Because SV index is routinely calculated and widely available, it could serve as the preferred echocardiographic measure to predict outcomes in AL amyloidosis patients.

AB - BACKGROUND: Heart involvement is the most important prognostic determinant in AL amyloidosis patients. Echocardiography is a cornerstone for the diagnosis and provides important prognostic information.METHODS AND RESULTS: We studied 754 patients with AL amyloidosis who underwent echocardiographic assessment at the Mayo Clinic, including a Doppler-derived measurement of stroke volume (SV) within 30 days of their diagnosis to explore the prognostic role of echocardiographic variables in the context of a well-established soluble cardiac biomarker staging system. Reproducibility of SV, myocardial contraction fraction, and left ventricular strain was assessed in a separate, yet comparable, study cohort of 150 patients from the Pavia Amyloidosis Center. The echocardiographic measures most predictive for overall survival were SV index <33 mL/min, myocardial contraction fraction <34%, and cardiac index <2.4 L/min/m2 with respective hazard ratios (95% confidence intervals) of 2.95 (2.37-3.66), 2.36 (1.96-2.85), and 2.32 (1.91-2.80). For the subset that had left ventricular strain performed, the prognostic cut point was -14% (hazard ratios, 2.70; 95% confidence intervals, 1.84-3.96). Each parameter was independent of systolic blood pressure, Mayo staging system (NT-proBNP [N-terminal pro-B-type natriuretic peptide] and troponin), and ejection fraction on multivariable analysis. Simple predictive models for survival, including biomarker staging along with SV index or left ventricular strain, were generated.CONCLUSIONS: SV index prognostic performance was similar to left ventricular strain in predicting survival in AL amyloidosis, independently of biomarker staging. Because SV index is routinely calculated and widely available, it could serve as the preferred echocardiographic measure to predict outcomes in AL amyloidosis patients.

U2 - 10.1161/CIRCIMAGING.117.006588

DO - 10.1161/CIRCIMAGING.117.006588

M3 - Article

C2 - 29752392

VL - 11

SP - e006588

JO - Circulation: Cardiovascular Imaging

JF - Circulation: Cardiovascular Imaging

SN - 1941-9651

IS - 5

ER -