Reactive Vasodilation Predicts Mortality in Primary Systemic Light-Chain Amyloidosis
| Autor: | Ageliki Laina, Georgios Georgiopoulos, I Petropoulos, Konstantinos Stellos, Georgia Trakada, Panagiota-Efstathia Nikolaou, Ioanna Andreadou, M. Lykka, D Delialis, Evangelos Terpos, Marina Karakitsou, Kimon Stamatelopoulos, Christos Papamichael, Constantinos Pamboukas, Maria Roussou, Irene Lambrinoudaki, Efstathios Kastritis, Meletios A. Dimopoulos, Marietta Charakida, Efstathios Manios, Aikaterini Gatsiou, Maria Gavriatopoulou, Fani Athanasouli |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Physiology brachial artery Vasodilation Blood Pressure 030204 cardiovascular system & hematology Immunoglobulin light chain Immunoglobulin Light-chain Amyloidosis 03 medical and health sciences 0302 clinical medicine Internal medicine medicine.artery medicine AL amyloidosis Laser-Doppler Flowmetry Humans Brachial artery 030304 developmental biology Aged Original Research 0303 health sciences business.industry Amyloidosis case-control studies autonomic nervous system Cold pressor test ultrasonography Middle Aged medicine.disease mortality 3. Good health Survival Rate Autonomic nervous system Regional Blood Flow Cardiology ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation Research |
| ISSN: | 0009-7330 |
| DOI: | 10.1161/circresaha.119.314862 |
| Popis: | Supplemental Digital Content is available in the text. Rationale: Cardiac involvement and hypotension dominate the prognosis of light-chain amyloidosis (AL). Evidence suggests that there is also peripheral vascular involvement in AL but its prognostic significance is unknown. Objective: To evaluate vascular dysfunction in patients with AL as a potential future area of intervention, we assessed the prognostic utility of flow-mediated dilatation (FMD), a marker of vascular reactivity, which is augmented under conditions of hypotension and autonomic dysfunction. Methods and Results: We prospectively evaluated 115 newly diagnosed untreated AL patients in whom FMD was measured. FMD in AL patients was significantly higher than age-, sex- and risk factors–matched controls (4.0% versus 2.32%; P=0.006) and comparable with control groups at lower cardiovascular risk (P>0.1). Amyloidosis patients presented increased plasma and exhaled markers of the NO pathway while their FMD significantly correlated with augmented sustained vasodilatation after sympathetic stimulation. Increased FMD (≥4.5%) was associated with early mortality (hazard ratio, 4.36; 95% CI, 1.41–13.5; P=0.010) and worse survival (hazard ratio, 2.11; 95% CI, 1.17–3.82; P=0.013), even after adjustment for Mayo stage, nerve involvement and low systolic blood pressure. This finding was confirmed in a temporal validation AL cohort (n=55; hazard ratio, 4.2; 95% CI, 1.45–12.3; P=0.008). FMD provided significant reclassification value over the best prognostic model (continuous Net Reclassification Index, 0.61; P=0.001). Finally, better hematologic response was associated with lower posttreatment FMD. Conclusions: FMD is relatively increased in AL and independently associated with inferior survival with substantial reclassification value. Reactive vasodilation merits further investigation as a novel risk biomarker in AL.Visual Overview: An online visual overview is available for this article. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|