Cardiopulmonary exercise testing in patients with Cardiac Amyloidosis

Clin Lymphoma Myeloma Leuk. 2021 Aug;21(8):545-548. doi: 10.1016/j.clml.2021.03.015. Epub 2021 Apr 23.

Abstract

Background: Cardiac involvement and dysfunction are common in patients presenting with AL and ATTR Amyloidosis. Cardiopulmonary exercise testing (CPET) performance is the gold standard to quantify functional capacity.

Patients and methods: In this study, we evaluated CPET measurements in 41 patients with cardiac Amyloidosis and their correlation with current amyloid specific staging criteria.

Results: In both AL and ATTR cardiac Amyloidosis, percent predicted peak VO2 is significantly reduced and correlates with biomarker abnormalities. The association of cardiac biomarkers with peak VO2 is stronger for AL Amyloidosis (NT-proBNP (r = -0.57, P=0.006), Troponin (r = -0.70, p < 0.001) than ATTR (NT-proBNP (r = -0.4, P = 0.04) and Troponin (r = -0.57, P = 0.002) despite lower left ventricular mass in the former, suggesting that this may be further evidence for light chain toxicity in AL amyloidosis.

Conclusion: Our findings suggest further evidence for AL toxicity.

Keywords: Cardiac amyloidosis; Cardiopulmonary testing.

MeSH terms

  • Aged
  • Amyloidosis / diagnosis*
  • Amyloidosis / pathology
  • Amyloidosis / physiopathology*
  • Biomarkers / blood
  • Cardiomyopathies / diagnosis*
  • Cardiomyopathies / pathology
  • Cardiomyopathies / physiopathology*
  • Exercise Test
  • Female
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Oxygen Consumption
  • Peptide Fragments / blood
  • Prognosis
  • Survival Analysis
  • Troponin / blood

Substances

  • Biomarkers
  • Peptide Fragments
  • Troponin
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain