Outcome of patients with cardiac amyloidosis admitted to an intensive care unit for acute heart failure

Autor: D. Fard, Thibaud Damy, Huy-Long Doan, Thomas d’Humieres, Julien Ternacle, François Roubille, Pascal Lim, Jean-Luc Dubois-Randé, Arnaud Galat, Pierre Squara, Leopold Oliver
Přispěvatelé: Université Paris-Est Créteil Val-de-Marne - Faculté de médecine (UPEC Médecine), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Ambroise Paré [AP-HP], Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), MORNET, Dominique
Rok vydání: 2018
Předmět:
Male
Time Factors
[SDV]Life Sciences [q-bio]
030204 cardiovascular system & hematology
law.invention
Patient Admission
0302 clinical medicine
Risk Factors
Interquartile range
law
Natriuretic Peptide
Brain
Odds Ratio
Clinical endpoint
Hospital Mortality
Registries
ComputingMilieux_MISCELLANEOUS
Aged
80 and over
education.field_of_study
Cardiogenic shock
Amyloidosis
General Medicine
Middle Aged
Intensive care unit
3. Good health
[SDV] Life Sciences [q-bio]
Intensive Care Units
Treatment Outcome
Acute Disease
Disease Progression
Cardiology
Female
Cardiomyopathies
Cardiology and Cardiovascular Medicine
medicine.drug
medicine.medical_specialty
Population
Shock
Cardiogenic
Outcomes
03 medical and health sciences
Internal medicine
Pronostic
medicine
Humans
education
Aged
Heart Failure
Chi-Square Distribution
business.industry
Hemodynamics
Acute heart failure
medicine.disease
Peptide Fragments
Insuffisance cardiaque
Logistic Models
Amylose cardiaque
Cardiac amyloidosis
Heart failure
Multivariate Analysis
Dobutamine
business
Biomarkers
Choc cardiogénique
030215 immunology
Zdroj: Archives of cardiovascular diseases
Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2018, ⟨10.1016/j.acvd.2018.03.004⟩
Archives of cardiovascular diseases, 2018, ⟨10.1016/j.acvd.2018.03.004⟩
ISSN: 1875-2136
1875-2128
DOI: 10.1016/j.acvd.2018.03.004
Popis: The outcome of cardiac amyloidosis (CA) has been reported mainly in stable populations; limited data are available in patients referred for acute heart failure (AHF) to an intensive cardiac care unit (ICCU).To address the characteristics and outcomes of patients with confirmed CA admitted to an ICCU for AHF and then to identify the predictors of evolution to cardiogenic shock.All patients with CA referred to an ICCU for AHF between 2009 and 2015 were included. The clinical endpoint was 3-month death. Data from the population with cardiogenic shock, obtained in a stable haemodynamic state, were matched with data from a control group to determine predictors of evolution to cardiogenic shock.Among the 421 patients followed for CA in our expert centre, 46 patients (mean age: 64±14 years; 65% light-chain [AL] CA) were referred to the ICCU for AHF (n=26 with cardiogenic shock). At 3 months, death occurred in 24 (52%) patients, mostly in the cardiogenic shock group (n=21/26, 81%). Most deaths occurred 5 days [interquartile range 3-9 days] after catecholamine infusion and 50% occurred in patients aged65 years. The majority of deaths were reported in patients with AL CA (n=19/24, 79%). Independent variables associated with in-hospital mortality were cardiogenic shock and uraemia level. N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration obtained in a stable haemodynamic state was the only predictor of short-term evolution to cardiogenic shock (odds ratio: 8.7, 95% confidence interval: 2.2-34.6), with an optimal cut-off of 4040pg/mL (sensitivity=92%; specificity=81%).The study confirms the dramatic mortality associated with CA when presenting as cardiogenic shock and underlines the limited efficiency of conventional treatments. Given the rapid occurrence of death in a young population, an alternative strategy to dobutamine support should be investigated in patients with elevated NT-proBNP concentration.
Databáze: OpenAIRE
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