First-phase ejection fraction as a potential early indicator for left ventricular function in cardiac amyloidosis
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Cardiac amyloidosis (CA) is crucial for prognosis in patients with light-chain amyloidosis, with left ventricular first-phase ejection fraction (LVEF1) being a more sensitive indicator for this condition than ejection fraction. This study aimed to assess LVEF1's value in informing the treatment and prognosis of patients with light-chain CA. Methods: A total of 119 patients with light-chain amyloidosis and LVEF ≥50% and suspected CA according to echocardiography were enrolled. After validation via cardiac magnetic resonance (CMR) or abdominal fat biopsy, these patients were split into a CA group (n=72) and non-CA group (n=47). Based on first hospitalization, echocardiography and blood biochemical data were obtained. After 1 year of chemotherapy, echocardiography and biochemical data were obtained again, and patients were divided into hematologic complete response (hemCR; n=26) and non-hemCR (n=38) groups. Analyses of subgroups comparing pre- and posttreatment were conducted, followed by survival analysis in all patients with CA (followed up until September 30, 2024). Results: 36.25%±8.74%; P<0.01). After 1 year of treatment, the LVEF1 in the hemCR group improved compared to that a year prior (32.62%±8.13% to 39.24%±7.36%; P<0.01), and the change in LVEF1 correlated with the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) (r=-0.761). During follow-up, 30 patients died (8 during the 1 year of treatment and 22 during the median 18-month posttreatment follow-up). Baseline LVEF1 had discriminatory ability for poor prognosis (hazard ratio =0.92, 95% confidence interval: 0.88-0.97; P=0.003). The optimal LVEF1 (Youden index) cutoff was 30%. Patients with CA and a baseline LVEF1 <30% demonstrated elevated NT-proBNP level, reduced left ventricular global longitudinal strain, and increased mortality risk. Conclusions: LVEF1 has the potential to be an early indicator of left ventricular function in patients with CA and preserved ejection fraction. It can both reflect subtle left ventricular function changes and aid in predicting prognosis.
Authors: Tongtong Huang, Chunxiao Su, Chunlan Jiang, Decai Zeng, Yongzhi Cai, Xiaofeng Zhang, Shuai Chang, Jun Luo, Ji Wu
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W4415655994
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