PMID- 33073249 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231107 IS - 2666-0873 (Electronic) IS - 2666-0873 (Linking) VI - 2 IP - 3 DP - 2020 Sep TI - Diuretic Dose and NYHA Functional Class Are Independent Predictors of Mortality in Patients With Transthyretin Cardiac Amyloidosis. PG - 414-424 LID - 10.1016/j.jaccao.2020.06.007 [doi] AB - BACKGROUND: With increasing diagnoses and available treatment options for transthyretin amyloidosis cardiomyopathy (ATTR-CM), risk stratification of ATTR-CM patients is imperative. OBJECTIVES: We hypothesized that diuretic dose and New York Heart Association (NYHA) functional class are independent predictors of mortality in ATTR-CM and would be incrementally additive to existent risk scores. METHODS: Consecutive ATTR-CM patients referred to a single center were identified. Adjusted Cox proportional hazards models determined the association between diuretic dose (furosemide equivalent in mg/kg) at time of diagnosis and the primary outcome of all-cause mortality. The incremental value of adding diuretic dose and NYHA functional class to existing ATTR-CM risk scores was assessed for discrimination and calibration. RESULTS: 309 patients were identified, with mean age 73.2 +/- 9.8 years, 84.1% male, and 66% wild type. Daily mean diuretic dose was 0.6 +/- 1.0 mg/kg and significantly associated with all-cause mortality (unadjusted hazard ratio: 2.12 per 1-mg/kg increase, [95% confidence interval: 1.71 to 2.61] and fully adjusted hazard ratio: 1.43 [95% confidence interval: 1.06 to 1.93]). Testing previously published ATTR risk scores, adding diuretic dose as categories (0 mg/kg, >0 to 0.5 mg/kg, >0.5 to 1 mg/kg, and >1 to 2 mg/kg) improved the area under the curve of the Mayo risk score from 0.693 to 0.767 and the UK risk score from 0.711 to 0.787 while preserving calibration. Adding NYHA functional class further improved the area under the curve to 0.798 and 0.816, respectively. CONCLUSIONS: Diuretic dose and NYHA functional class are independent predictors of mortality in ATTR-CM patients and provide incremental value to existing ATTR-CM risk scores. FAU - Cheng, Richard K AU - Cheng RK AD - Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington. FAU - Levy, Wayne C AU - Levy WC AD - Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington. FAU - Vasbinder, Alexi AU - Vasbinder A AD - Department of Health Informatics, School of Nursing, University of Washington, Seattle, Washington. FAU - Teruya, Sergio AU - Teruya S AD - Division of Cardiology, Columbia University Irving Medical Center, New York, New York. FAU - De Los Santos, Jeffeny AU - De Los Santos J AD - Division of Cardiology, Columbia University Irving Medical Center, New York, New York. FAU - Leedy, Douglas AU - Leedy D AD - Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington. FAU - Maurer, Mathew S AU - Maurer MS AD - Division of Cardiology, Columbia University Irving Medical Center, New York, New York. LA - eng GR - R21 HL140445/HL/NHLBI NIH HHS/United States GR - K24 AG036778/AG/NIA NIH HHS/United States GR - F31 NR018588/NR/NINR NIH HHS/United States GR - R01 HL139671/HL/NHLBI NIH HHS/United States GR - R21 AG058348/AG/NIA NIH HHS/United States PT - Journal Article DEP - 20200915 PL - United States TA - JACC CardioOncol JT - JACC. CardioOncology JID - 101761697 CIN - JACC CardioOncol. 2020 Sep 15;2(3):425-427. PMID: 34396249 PMC - PMC7561022 MID - NIHMS1631995 OTO - NOTNLM OT - cardiac amyloidosis OT - heart failure OT - transthyretin EDAT- 2020/10/20 06:00 MHDA- 2020/10/20 06:01 PMCR- 2020/09/15 CRDT- 2020/10/19 06:01 PHST- 2020/10/19 06:01 [entrez] PHST- 2020/10/20 06:00 [pubmed] PHST- 2020/10/20 06:01 [medline] PHST- 2020/09/15 00:00 [pmc-release] AID - S2666-0873(20)30156-3 [pii] AID - 10.1016/j.jaccao.2020.06.007 [doi] PST - ppublish SO - JACC CardioOncol. 2020 Sep;2(3):414-424. doi: 10.1016/j.jaccao.2020.06.007. Epub 2020 Sep 15.