Clinical and prognostic significance of central and obstructive apnoeas in patients with transthyretin cardiac amyloidosis
Year: 2024
Type: article
Study design: Observational Study
Abstract: AIMS: Central apnoea (CA) and obstructive apnoea (OA) are highly prevalent in patients with chronic heart failure (HF), and transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized HF aetiology. This study aims to investigate the prevalence and impact of CA and OA in patients with ATTR-CA. METHODS AND RESULTS: Consecutive patients with ATTR-CA who underwent 24 h ambulatory cardiorespiratory monitoring were enlisted for an evaluation of the prevalence and severity of breathing disorders. The severity of these disorders was quantified using the apnoea-hypopnoea index (AHI). Accordingly, the patients were categorized as having normal breathing (NB, AHI <5 events/h), OA (AHI ≥5 events/h with >50% being obstructive), or CA (AHI >5 events/h with ≥50% being central). The primary endpoint at follow-up was all-cause mortality. Out of 142 patients enrolled (n = 142, aged 77 ± 7 years, 91% males, 96% wild-type ATTR-CA), considering the 24 h monitoring, 20% had NB (39% at daytime and 8% at nighttime), 35% had CA (45% at daytime and 39% at nighttime), and 45% had OA (25% at daytime and 54% at nighttime). After a median 2.3-year (1.4-3.3 years) follow-up, 24 h, daytime, and nighttime AHIs were higher in non-survivors vs. survivors (all P < 0.05), independently of the prevalent apnoea type (P = 0.64). At multivariable regression analysis (adjusted for the possible clinical, echocardiographic, and biohumoral confounders), nighttime AHI ≥30 events/h {hazard ratio 2.37 [95% confidence interval (CI) 1.07-5.23], P = 0.033} and high-sensitivity troponin T [hazard ratio 2.43 (95% CI 1.42-4.17), P = 0.001] were predictors of mortality. CONCLUSION: Both CA and OA are highly prevalent, both at daytime and nighttime, in patients with ATTR-CA and are associated with higher mortality.
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W4402752012