Presence of transthyretin amyloidosis cardiomyopathy influences the prognosis of patients with acute decompensated heart failure undergoing cardiac rehabilitation

Abstract

[Purpose] This study aimed to investigate the changes in physical function during hospitalization and their impact on the outcomes of patients with transthyretin amyloidosis cardiomyopathy who experienced acute decompensated heart failure and underwent acute cardiac rehabilitation. [Participants and Methods] A matched cohort of 18 and 54 patients with and without transthyretin amyloidosis cardiomyopathy, respectively, was created and analyzed. [Results] Compared to patients without transthyretin amyloidosis cardiomyopathy, those with transthyretin amyloidosis showed similar improvements in grip strength, quadriceps isometric strength, short physical performance battery, and usual gait speed during hospitalization. However, transthyretin amyloidosis cardiomyopathy was associated with a significantly increased risk of both rehospitalization due to heart failure and all-cause mortality. [Conclusion] Although the extent of changes in physical function during hospitalization was similar in patients with and without transthyretin amyloidosis cardiomyopathy, transthyretin amyloidosis cardiomyopathy was associated with poorer outcomes.

Keywords: All-cause mortality; Physical function; Rehospitalization due to heart failure.

Fig. 1.

Screening and data analysis. Cardiac rehabilitation (CR) was prescribed for all patients. *age, sex, BMI, NT-proBNP, LVEF, hospitalization due to heart failure within 1-year, CR start date after admission, atrial fibrillation, diabetes, hypertension, chronic kidney disease, dyslipidemia, and assessment of physical function at the start of rehabilitation (grip strength, QIS, SPPB, and usual gait speed). BMI: body mass index; LVEF: left ventricular ejection fraction; ATTR-CM: transthyretin amyloidosis cardiomyopathy; NT-proBNP: N-terminal pro-brain natriuretic peptide; QIS: quadriceps isometric strength; SPPB: short physical performance battery.

Fig. 2.

Kaplan–Meier curves of the risk of outcome. In Kaplan–Meier curves analysis, before propensity score matching, ATTR-CM was not associated with rehospitalization due to heart failure (log-rank: A, p=0.17 and B, p<0.001, respectively). After propensity score matching, ATTR-CM was significantly associated with rehospitalization due to heart failure and all-cause mortality (log-rank: C, p<0.01 and D, p<0.001, respectively). ATTR-CM: transthyretin amyloidosis cardiomyopathy.