Prognostic implications of pericardial and pleural effusion in patients with cardiac amyloidosis
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ORIGINAL PAPER
Prognostic implications of pericardial and pleural effusion in patients with cardiac amyloidosis Christina Binder1 · Franz Duca1 · Thomas Binder1 · René Rettl1 · Theresa Marie Dachs1 · Benjamin Seirer1 · Luciana Camuz Ligios1 · Fabian Dusik1 · Christophe Capelle1 · Hong Qin1 · Hermine Agis2 · Renate Kain3 · Christian Hengstenberg1 · Roza Badr Eslam1 · Diana Bonderman1 Received: 23 April 2020 / Accepted: 25 June 2020 © The Author(s) 2020
Abstract Background Pericardial and pleural effusion are common findings in patients with cardiac amyloidosis (CA). It is not known, whether effusions correlate with right ventricular (RV) function in these patients. Furthermore, data on the prognostic significance of pleural and pericardial effusion in CA is scarce. Methods Patients with transthyretin (ATTR) and light chain (AL) CA were included in a clinical registry. All patients underwent transthoracic echocardiography at baseline. The presence of pericardial and pleural effusion was determined in every patient. The clinical endpoint was defined as cardiac death or heart failure hospitalization. Results In total, 143 patients were analysed. Of these, 85 patients were diagnosed with ATTR and 58 patients with AL. Twenty-four patients presented with isolated pericardial effusion and 35 with isolated pleural effusion. In 19 patients, both pericardial and pleural effusion were found and in 65 patients no effusion was present at baseline. The presence of pleural effusion correlated well with poor RV function, measured by global RV free-wall strain (p = 0.007) in patients with AL, but not in ATTR. No such correlation could be found for pericardial effusion in either amyloidosis subtype. Patients with AL presenting with pleural effusion had worse outcomes compared to patients with pericardial effusion alone or no effusion at baseline. In the ATTR group, there was no difference in outcomes according to presence and type of effusion. Conclusion More than 50% of patients with CA presented with pleural and/or pericardial effusions. While pleural effusion was clearly associated with poor RV function in AL, we were not able to detect this association with pericardial effusion. Keywords Cardiac amyloidosis · Echocardiography · Effusion · Right ventricle · Speckle tracking imaging · Strain · Outcome
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-020-01698-7) contains supplementary material, which is available to authorized users. * Roza Badr Eslam [email protected] * Diana Bonderman [email protected] 1
Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18‑20, 1090 Vienna, Austria
2
Department of Internal Medicine I, Department of Oncology, Medical University of Vienna, Vienna, Austria
3
Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
Pleural and pericardial effusions are often seen in patients with heart failure (HF) a
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