Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is associated with a progressive reduction of functional capacity. The progression of cardiopulmonary exercise testing (CPET) parameters over time is still unknown. Methods: In this study 55 patients with ATTR-CM underwent two serial cardiological evaluation and CPET in a National Referral Center for cardiac amyloidosis (Careggi University hospital, Florence). Results: Forty-three patients (78%) had wild type ATTR. Median age was 80 (76-83) years, 50 patients (91%) were men. At baseline median peak oxygen consumption (pVO2) was 15 (12-18) ml/kg/min, percentage of predicted pVO2 (%ppVO2) was 71 (60-83) % and VE/VCO2 slope was 31 (26-34). After a median follow-up of 14 (13-16) months, pVO2, %ppVO2 and VE/VCO2 slope were significantly worsened (-1.29ml/kg/min, CI -1.85 to -0.74, p<0.01, -4.5% CI -6.9 to -2.02, p<0.01, 8.6 CI 6 to 11, p<0.01, respectively). Furthermore, exercise time (-39 seconds, CI -59 to -19, p<0.01), exercise tolerance (-0.47 METs, CI -0.69 to -0.2, p<0.01) and peak systolic pressure (-10.8 mmHg, CI -16.2 to -5.4, p<0.01) were significantly reduced. The worsening in CPET variables did not correspond to a significant change in echocardiographic parameters. Conclusions: Cardiorespiratory response to exercise significantly worsened over a short period of time in patients with ATTR-CM. Serial CPET may be useful to identify early disease progression.

Serial changes in CPET parameters in untreated patients with transthyretin cardiac amyloidosis / Argirò, Alessia; Silverii, Maria Vittoria; Burgisser, Costanza; Fattirolli, Francesco; Baldasseroni, Samuele; Di Mario, Carlo; Zampieri, Mattia; Biagioni, Giulia; Mazzoni, Carlotta; Chiti, Chiara; Allinovi, Marco; Ungar, Andrea; Perfetto, Federico; Cappelli, Francesco. - In: CANADIAN JOURNAL OF CARDIOLOGY. - ISSN 0828-282X. - STAMPA. - (2023), pp. 1-12. [10.1016/j.cjca.2023.09.028]

Serial changes in CPET parameters in untreated patients with transthyretin cardiac amyloidosis

Silverii, Maria Vittoria;Burgisser, Costanza;Fattirolli, Francesco;Baldasseroni, Samuele;Di Mario, Carlo;Zampieri, Mattia;Mazzoni, Carlotta;Chiti, Chiara;Allinovi, Marco;Ungar, Andrea;Perfetto, Federico;Cappelli, Francesco
2023

Abstract

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is associated with a progressive reduction of functional capacity. The progression of cardiopulmonary exercise testing (CPET) parameters over time is still unknown. Methods: In this study 55 patients with ATTR-CM underwent two serial cardiological evaluation and CPET in a National Referral Center for cardiac amyloidosis (Careggi University hospital, Florence). Results: Forty-three patients (78%) had wild type ATTR. Median age was 80 (76-83) years, 50 patients (91%) were men. At baseline median peak oxygen consumption (pVO2) was 15 (12-18) ml/kg/min, percentage of predicted pVO2 (%ppVO2) was 71 (60-83) % and VE/VCO2 slope was 31 (26-34). After a median follow-up of 14 (13-16) months, pVO2, %ppVO2 and VE/VCO2 slope were significantly worsened (-1.29ml/kg/min, CI -1.85 to -0.74, p<0.01, -4.5% CI -6.9 to -2.02, p<0.01, 8.6 CI 6 to 11, p<0.01, respectively). Furthermore, exercise time (-39 seconds, CI -59 to -19, p<0.01), exercise tolerance (-0.47 METs, CI -0.69 to -0.2, p<0.01) and peak systolic pressure (-10.8 mmHg, CI -16.2 to -5.4, p<0.01) were significantly reduced. The worsening in CPET variables did not correspond to a significant change in echocardiographic parameters. Conclusions: Cardiorespiratory response to exercise significantly worsened over a short period of time in patients with ATTR-CM. Serial CPET may be useful to identify early disease progression.
2023
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Argirò, Alessia; Silverii, Maria Vittoria; Burgisser, Costanza; Fattirolli, Francesco; Baldasseroni, Samuele; Di Mario, Carlo; Zampieri, Mattia; Biagioni, Giulia; Mazzoni, Carlotta; Chiti, Chiara; Allinovi, Marco; Ungar, Andrea; Perfetto, Federico; Cappelli, Francesco
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1344532
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