Cardiac amyloidosis and left atrial appendage closure. The CAMYLAAC study.

Autor: Amat-Santos IJ; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. Electronic address: ijamat@gmail.com., Delgado-Arana JR; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Cruz-González I; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, Spain., Gutiérrez H; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., García-Bolao I; Servicio de Cardiología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain., Millán X; Servicio de Cardiología, Hospital Universitario Sant Pau, Barcelona, Spain., Tirado-Conte G; Servicio de Cardiología, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Ruiz-Nodar JM; Servicio de Cardiología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain., Mohandes M; Servicio de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain., Palazuelos J; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain; Servicio de Cardiología, Hospital La luz, Madrid, Spain., Torres Saura F; Servicio de Cardiología, Hospital de Vinalopó, Elche, Alicante, Spain., Del Valle R; Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain., Valero Picher E; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain., Núñez García JC; Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, Spain., Gómez I; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Albarrán Rincón R; Servicio de Cardiología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain., Arzamendi D; Servicio de Cardiología, Hospital Universitario Sant Pau, Barcelona, Spain., Nombela-Franco L; Servicio de Cardiología, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Korniiko L; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Barrero A; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Santos-Martínez S; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Serrador A; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., San Román JA; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Jazyk: English; Spanish; Castilian
Zdroj: Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2023 Jul; Vol. 76 (7), pp. 503-510. Date of Electronic Publication: 2022 Aug 05.
DOI: 10.1016/j.rec.2022.08.001
Abstrakt: Introduction and Objectives: Transthyretin cardiac amyloidosis (ATTR-CA) patients often have atrial fibrillation and increased bleeding/thrombogenic risks. We aimed to evaluate outcomes of left atrial appendage closure (LAAC) compared with patients without a known diagnosis of CA.
Methods: Comparison at long-term of patients diagnosed with ATTR-CA who underwent LAAC between 2009 and 2020 and those without a known diagnosis of CA.
Results: We studied a total of 1159 patients. Forty patients (3.5%) were diagnosed with ATTR-CA; these patients were older and had more comorbidities, higher HAS-BLED and CHA 2 DS 2 -VASc scores, and lower left ventricular function. Successful LAAC was achieved in 1137 patients (98.1%) with no differences between groups. Regarding in-hospital and follow-up complications, there were no differences between the groups in ischemic stroke (5% vs 2.5% in those without a known diagnosis of CA; P=.283), hemorrhagic stroke (2.5% and 0.8% in the control group; P=.284), major or minor bleeding. At the 2-year follow-up, there were no significant differences in mortality (ATTR-CA: 20% vs those without known CA: 13.6%, 0.248); however, the at 5-year follow-up, ATTR-CA patients had higher mortality (40% vs 19.2%; P <.001) but this difference was unrelated to hemorrhagic complications or ischemic stroke.
Conclusions: LAAC could reduce the risk of bleeding complications and ischemic cerebrovascular events without increasing the rate of early or mid-term complications. Although long-term survival was impaired in ATTR-CA patients, it was comparable to that of patients without a known diagnosis of CA at the 2-year follow-up, suggesting that LAAC for patients with ATTR-CA might not be futile.
(Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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