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. 2022 Feb;9(1):740-750.
doi: 10.1002/ehf2.13663. Epub 2021 Nov 3.

Cardiovascular outcomes after cardiac resynchronization therapy in cardiac amyloidosis

Kilian Fischer  1 , Nicolas Lellouche  2 , Thibaud Damy  2 , Raphaël Martins  3 , Nicolas Clementy  4 , Arnaud Bisson  4 , François Lesaffre  5 , Madeline Espinosa  5 , Rodrigue Garcia  6 , Bruno Degand  6 , Guillaume Serzian  7 , François Jourda  8 , Olivier Huttin  9 , Jean-Baptiste Guichard  10 , Hervé Devilliers  11 , Jean-Christophe Eicher  1 , Gabriel Laurent  1 , Charles Guenancia  1   12
Affiliations

Cardiovascular outcomes after cardiac resynchronization therapy in cardiac amyloidosis

Kilian Fischer et al. ESC Heart Fail. 2022 Feb.

Abstract

Aims: Cardiac resynchronization therapy (CRT) is highly effective in dilated cardiomyopathy (DCM) patients with impaired left ventricular ejection fraction (LVEF) and left bundle block branch. In cardiac amyloidosis (CA) patients, left ventricular dysfunction and conduction defects are common, but the potential of CRT to improve cardiac remodelling and survival in this particular setting remains undefined. We investigated cardiovascular outcomes in CA patients after CRT implantation in terms of CRT echocardiographic response and major cardiovascular events (MACEs).

Methods and results: Our retrospective study included 47 CA patients implanted with CRT devices from January 2012 to February 2020, in nine French university hospitals (77 ± 6 years old, baseline LVEF 30 ± 8%) compared with propensity-matched (1:1 for age, LVEF at implantation, and CRT indication) DCM patients with a CRT device. CA patients had lower rates of CRT response (absolute delta LVEF ≥ 10%) compared with DCM patients (36% vs. 70%, P = 0.002). After multivariate Cox analysis, CA was independently associated with MACE (hospitalization for heart failure/cardiovascular death) [hazard ratio (HR) 3.73, 95% confidence interval (CI) 1.85-7.54, P < 0.001], along with the absence of CRT response (HR 3.01, 95% CI 1.56-5.79, P = 0.001). The presence of echocardiographic CRT response (absolute delta LVEF ≥ 10%) was the only predictive factor of MACE-free survival in CA patients (HR 0.36, 95% CI 0.15-0.86, P = 0.002).

Conclusion: Compared with a matched cohort of DCM patients, CA patients had a lower rate of CRT response and consequently a worse cardiovascular prognosis after CRT implantation. However, CRT could be beneficial even in CA patients given that CRT response was associated with better cardiac outcomes in this population.

Keywords: Cardiac amyloidosis; Cardiac resynchronization therapy; Heart failure; Implantable cardioverter defibrillator; Pacemaker.

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Conflict of interest statement

T.D. reports grants and personal fees from Pfizer and Ionis‐Akcea and personal fees from Alnylam and Neurimmune, during the conduct of the study. G.L. reports personal fees from Abbott, Biosense Webster, MicroPort CRM, Boston Scientific, Medtronic, and Biotronik, outside the submitted work. C.G. reports personal fees from MicroPort CRM, Boston Scientific, and Medtronic, outside the submitted work. J.‐B.G. reports personal fees from Abbott and non‐financial support from Bayer, outside the submitted work. N.C. reports personal fees from Medtronic, outside the submitted work. F.L. reports non‐financial support from MicroPort and Johnson & Johnson and personal fees from Meda Pharma, Sanofi, Bayer, and Pfizer, outside the submitted work. The other authors have nothing to declare.

Figures

Figure 1
Figure 1
Flow chart of the study. AL, amyloidosis with immunoglobulin light chains; ATTR, transthyretin amyloidosis; CA, cardiac amyloidosis; CRT, cardiac resynchronization therapy.
Figure 2
Figure 2
Estimated major cardiovascular event (MACE)‐free survival rates after cardiac resynchronization therapy implantation in cardiac amyloidosis and matched dilated cardiomyopathy patients. (A) Unadjusted data. (B) Adjusted for differences in clinical characteristics and concomitant diseases by Cox multivariate hazard regression. P value refers to log‐rank test for (A) and Cox model for (B).
See this image and copyright information in PMC

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