PMID- 27194782 OWN - NLM STAT- MEDLINE DCOM- 20171102 LR - 20190221 IS - 2047-2412 (Electronic) IS - 2047-2404 (Linking) VI - 17 IP - 9 DP - 2016 Sep TI - Prognostic value of left atrial function in systemic light-chain amyloidosis: a cardiac magnetic resonance study. PG - 961-9 LID - 10.1093/ehjci/jew100 [doi] AB - BACKGROUND: Cardiac involvement in systemic light-chain amyloidosis (AL) imparts an adverse impact on outcome. The left atrium (LA), by virtue of its anatomical location and muscular wall, is commonly affected by the amyloid process. Although LA infiltration by amyloid fibrils leads to a reduction in its pump function, the infiltration of the left ventricular (LV) myocardium results in diastolic dysfunction with subsequent increase in filling pressures and LA enlargement. Even though left atrial volume (LAV) is an independent prognostic marker in many cardiomyopathies, its value in amyloid heart disease remains to be determined. In addition, few data are available as to the prognostic value of LA function in systemic AL. Using cardiac magnetic resonance (CMR), the current study aims to assess the prognostic significance of the maximal LAV and total LA emptying fraction (LAEF) in patients with AL. METHODS AND RESULTS: Fifty-four consecutive patients (age 66 +/- 10 years, 59% males) with confirmed systemic AL and mean LV ejection fraction of 60 +/- 12% underwent CMR. As compared with patients with no or minimal cardiac involvement (Mayo Clinic [MC] stage I), those at moderate and high risk (MC stages II and III) had significantly larger indexed maximal LAV (36 +/- 15 vs. 46 +/- 13 vs. 52 +/- 19 mL/m(2), P = 0.03) and indexed minimal LAV (20 +/- 6 vs. 34 +/- 11 vs. 44 +/- 17 mL/m(2), P < 0.001), lower LAEF (42 +/- 9 vs. 26 +/- 13 vs. 16 +/- 9%, P < 0.0001) but similar LVEF. Furthermore, myocardial late gadolinium enhancement (LGE) was more frequent and significantly associated with lower LAEF. LAEF was also significantly lower in symptomatic (NHYA >/= II, 22 +/- 14%) as compared with asymptomatic patients (NYHA class I, 33 +/- 13%, P = 0.006). Two-year survival rate was lower in patients with LAEF 16% (37 +/- 11 vs. 94 +/- 4%, P = 0.001). In multivariate analysis, lower LAEF remained independently associated with a higher risk of 2-year mortality (HR = 1.08 per 1% decrease, 95% CI: 1.02-1.15, P = 0.003). CONCLUSION: In patients with systemic AL, LAEF as assessed by CMR is associated with NYHA functional class, MC stage, myocardial LGE and 2-year mortality. CI - Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author 2016. For permissions please email: journals.permissions@oup.com. FAU - Mohty, Dania AU - Mohty D AD - CHU Dupuytren, Limoges, France French National Reference Center for Light chains Amyloidosis and Other Diseases by Monoclonal Immunoglobulin Deposits, Limoges University, Limoges, France dania.mohty@chu-limoges.fr. FAU - Boulogne, Cyrille AU - Boulogne C AD - CHU Dupuytren, Limoges, France. FAU - Magne, Julien AU - Magne J AD - CHU Dupuytren, Limoges, France. FAU - Varroud-Vial, Nicolas AU - Varroud-Vial N AD - CHU de la Miletrie, Poitiers, France. FAU - Martin, Sylvain AU - Martin S AD - CHU Dupuytren, Limoges, France. FAU - Ettaif, Hind AU - Ettaif H AD - CHU Dupuytren, Limoges, France. FAU - Fadel, Bahaa M AU - Fadel BM AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. FAU - Bridoux, Frank AU - Bridoux F AD - CHU de la Miletrie, Poitiers, France. FAU - Aboyans, Victor AU - Aboyans V AD - CHU Dupuytren, Limoges, France. FAU - Damy, Thibaud AU - Damy T AD - CHU Henri Mondor, Creteil, France. FAU - Jaccard, Arnaud AU - Jaccard A AD - CHU Dupuytren, Limoges, France French National Reference Center for Light chains Amyloidosis and Other Diseases by Monoclonal Immunoglobulin Deposits, Limoges University, Limoges, France. LA - eng PT - Comparative Study PT - Journal Article DEP - 20160518 PL - England TA - Eur Heart J Cardiovasc Imaging JT - European heart journal. Cardiovascular Imaging JID - 101573788 RN - 0 (Immunoglobulin Light Chains) SB - IM CIN - Eur Heart J Cardiovasc Imaging. 2016 Sep;17 (9):978-80. PMID: 27378771 MH - Age Factors MH - Aged MH - Amyloidosis/*diagnostic imaging/mortality/physiopathology MH - Analysis of Variance MH - Cardiomyopathies/*diagnostic imaging/mortality/physiopathology MH - Cohort Studies MH - Confidence Intervals MH - Databases, Factual MH - Female MH - France MH - Heart Atria/*diagnostic imaging/pathology MH - Humans MH - *Image Interpretation, Computer-Assisted MH - Immunoglobulin Light Chains/blood MH - Immunoglobulin Light-chain Amyloidosis MH - Kaplan-Meier Estimate MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Prognosis MH - Proportional Hazards Models MH - Prospective Studies MH - ROC Curve MH - Risk Assessment MH - Severity of Illness Index MH - Sex Factors MH - Stroke Volume/*physiology MH - Survival Analysis OTO - NOTNLM OT - AL amyloidosis OT - Cardiac magnetic resonance OT - Left atrial function OT - Prognosis EDAT- 2016/05/20 06:00 MHDA- 2017/11/03 06:00 CRDT- 2016/05/20 06:00 PHST- 2015/12/28 00:00 [received] PHST- 2016/04/15 00:00 [accepted] PHST- 2016/05/20 06:00 [entrez] PHST- 2016/05/20 06:00 [pubmed] PHST- 2017/11/03 06:00 [medline] AID - jew100 [pii] AID - 10.1093/ehjci/jew100 [doi] PST - ppublish SO - Eur Heart J Cardiovasc Imaging. 2016 Sep;17(9):961-9. doi: 10.1093/ehjci/jew100. Epub 2016 May 18.