Incidence and determinants of atrial fibrillation in patients with wild-type transthyretin cardiac amyloidosis.

Autor: Fumagalli C; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy., Zampieri M; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy., Argirò A; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy. Electronic address: argiro.alessia@gmail.com., Tassetti L; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy., Rossi G; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy., Musumeci B; Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy., Tini G; Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy., Russo D; Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy., Sclafani M; Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy., Cipriani A; Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy., Sinigiani G; Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy., Di Bella G; Department of Cardiology, University of Messina, Messina, Italy., Licordari R; Department of Cardiology, University of Messina, Messina, Italy., Canepa M; Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine, University of Genoa, Italy., Vianello PF; Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Merlo M; Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy., Porcari A; Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy., Rossi M; Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy., Sinagra G; Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy., Rapezzi C; Cardiothoracic Department, University of Ferrara, Ferrara, Italy., Di Mario C; Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy., Ungar A; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy., Olivotto I; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy., Perfetto F; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy., Cappelli F; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2023 Dec 01; Vol. 392, pp. 131346. Date of Electronic Publication: 2023 Sep 07.
DOI: 10.1016/j.ijcard.2023.131346
Abstrakt: Background: Data on the incidence and factors associated with de novo atrial fibrillation (AF) in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is limited. We described the incidence and factors associated with de novo AF in patients diagnosed with ATTRwt-CA to drive tailored arrhythmia screening.
Methods: Multicenter, retrospective, observational cohort study performed in six referral centers for CA. All consecutive patients diagnosed with ATTRwt-CA between 2004 and 2020 with >6-month follow up (FU) were enrolled and divided into three groups according to presence of AF: (1)patients with 'known AF'; (2)patients in 'sinus rhythm' and (3)patients developing 'de novo AF' during FU. Incidence and factors associated with AF in patients with ATTRwt were the primary outcomes.
Results: Overall, 266 patients were followed for a median of 19 [11-33] months: 148 (56%) with known AF, 84 (31.6%) with sinus rhythm, and 34 (12.8%) with de novo AF. At Fine-Gray competing risk analysis to account for mortality, PR (sub-distribution hazard ratio [SHR] per Δms: 1.008, 95% C.I. 1.001-1.013, p = 0.008), QRS (SHR per Δms: 1.012, 95% C.I. 1.001-1.022, p = 0.046) and left atrial diameter ≥ 50 mm (SHR: 2.815,95% C.I. 1.483-5.342, p = 0.002) were associated with de novo AF. Patients with at least two risk factors (PR ≥ 200 ms, QRS ≥ 120 ms or LAD≥50 mm) had a higher risk of developing de novo AF compared to patients with no risk factors (HR 14.918 95% C.I. 3.242-31.646, p = 0.008).
Conclusions: At the end of the study almost 70% patients had AF. Longer PR and QRS duration and left atrial dilation are associated with arrhythmia onset.
Competing Interests: Declaration of Competing Interest none to declare for the present work. All authors participated in the research and preparation of the manuscript.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: