Cardiac Resynchronization Therapy, Remodeling, and Outcome in Patients With Amyloid Transthyretin Cardiomyopathy
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background Transthyretin amyloid cardiomyopathy (ATTR‐CM) has a specific pathophysiology, with myocardial stiffening and systolic dysfunction only in advanced stages. We aimed to investigate the response to cardiac resynchronization therapy (CRT) in ATTR‐CM compared with heart failure. Methods In this multicenter, observational study, patients with ATTR‐CM receiving CRT (n=101) were matched to patients without amyloid cardiomyopathy by sex, age, and implantation type (CRT with versus without defibrillator versus conduction system pacing, upgrade versus first implant). We evaluated changes in QRS duration and echocardiographic parameters following CRT implantation and at the most recent available assessments. The study end points were all‐cause death alone or combined with heart failure hospitalization. Results Patients with ATTR‐CM (median age, 76 [interquartile range, 72–83] years, 98% men, left ventricular (LV) ejection fraction 30% [26–33]) showed greater QRS shortening after CRT implantation ( P =0.012), but not after a median of around 1 year ( P =0.152). There were no significant differences in the absolute LV ejection fraction changes immediately after implantation (+7 [+2/+10] versus +3 [0/+9] units; P =0.124), or to the last echo ( P =0.796), which was performed after 1.3 years in patients with ATTR‐CM and 2.9 years in patients without amyloid cardiomyopathy. Patients with ATTR‐CM had a shorter survival than controls ( P <0.001 for both end points). Patients with ATTR‐CM experiencing an early improvement in LV ejection fraction had a longer survival (log‐rank, 4.3; P =0.038). Conclusions Following CRT implantation, patients with ATTR‐CM show QRS narrowing and improvement in LV ejection fraction, not different from patients without amyloid cardiomyopathy. Early favorable LV remodeling seems to be associated with a lower risk of all‐cause death.
Authors: Alberto Aimo, Martina Nesti, Giuseppe Vergaro, Ammar M. Killu, Dimitrios Bampatsias, Daniela Tomasoni, Cinzia Forleo, Francesco Musca, Matteo Serenelli, Julie Rosenthal, Sergio L. Teruya, Nader J. Al‐Shakarchi, Mariel S. Tameze, Vincenzo Castiglione, Alessio Nicolai, Giorgia Panichella, Riccardo Saro, Aldostefano Porcari, Giulio Sinigiani, Vera Fico, Elisa Frau, Reem Matar, Andrea I. Guaricci, Giacomo Tini, Alberto Cipriani, Maria B. Musumeci, Simone Longhi, Cristina Chimenti, Marco Metra, Martha Grogan, Federico Perfetto, Francesco Cappelli, Marco Merlo, Gianfranco Sinagra, Mathew S. Maurer, Ahmad Masri, Michele Emdin
Institutions: Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Mayo Clinic, Columbia University, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, University of Bari Aldo Moro, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, University of Ferrara, Mayo Clinic Hospital, Azienda Ospedaliero-Universitaria Careggi, University of Trieste, ERN GUARD-Heart, University of Padua, Azienda Ospedale - Università Padova, Sapienza University of Rome, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, Policlinico Umberto I, Oregon Health & Science University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
OpenAlex ID: W4416127296