Left Ventricular Ejection Time on Echocardiography Predicts Long-Term Mortality in Light Chain Amyloidosis
published online 02 November 2009.
Objective
Light chain amyloidosis (AL) is associated with high mortality. The aim was to identify echocardiographic parameters that predict AL long-term mortality.
Methods
Forty-two subjects with biopsy-proven AL (43% were female; aged 61 ± 12 years) underwent echocardiography and were followed 29 ± 16 months (median 29.4 months). Standard echocardiographic and clinical parameters and heart failure (HF) class were tested using univariate/multivariable Cox proportional hazard regression analyses to identify markers of mortality.
Results
Twenty-three subjects died, with a 1-year mortality of 44%. Univariate predictors of mortality were HF class (P < .001), left ventricular systolic ejection time (ET) (P = .002), alkaline phosphatase (P < .001), and aspartate and alanine aminotransferase (P = .003 each). On multivariable analysis, only HF class (hazard ratio [HR] 4.86; 95% confidence interval [CI], 1.58-14.9; P = .006), ET (10 ms increase; HR 0.87; CI, 0.78-0.97; P = .01), and alkaline phosphatase (10 U/L increase; HR 1.04; CI, 1.01-1.06; P = .01) were prognostic. ET ≤ 240 ms had a sensitivity of 61% and a specificity of 90% in predicting 1-year mortality and a sensitivity of 73% and a specificity of 90% in predicting 1-year cardiac mortality.
Conclusion
AL amyloidosis was associated with high long-term mortality. Among echocardiographic and clinical parameters, only ET and alkaline phosphatase had incremental value to HF class in predicting mortality. This may be useful to identify high-risk patients.
aCardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
bBiostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
cHematology-Oncology Division, Medical College of Wisconsin, Milwaukee, Wisconsin
Reprint requests: Raymond Q. Migrino, MD, Medical College of Wisconsin-CVM, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226.
The study was supported by the American Heart Association Grant in Aid 0855683G, National Institutes of Health R21HL092344-01A1, GCRC M01-RR00058 and Kirschtein National Research Service Award, Amyloidosis Research Foundation, American Cancer Society, and Greater Milwaukee Foundation. The Biostatistics Consulting Service is supported by the Division of Biostatistics and the Clinical Translational Science Institute of Southeast Wisconsin.
The authors had full access to the data and take responsibility for its integrity. All authors have read and agree to the article as written.
ABSTRACT