Abstract Body: Introduction - Transthyretin Amyloid Cardiomyopathy (ATTR-CM) is a unique type of HFpEF. It can be monitored across multiple clinical markers, but the independent predictive value of markers is still under investigation. We aimed to rank prioritize 4 clinical markers to predict cardiac events in ATTR-CM.
Methods - A cohort of 147 patients with ATTR-CM were pooled from clinical data. From this cohort, 4 clinical markers were analyzed [>30m reduction in 6MWT, >5 drop in KCCQ >20% change in eGFR, and >25% change in NT-ProBNP. Finding the overlap in worsening markers (Jaccard index) and the predictive value for hospitalization (temporal lead time analysis).
Results- Across the clinical markers or clincal end-point, 41% of the participants showed “worsening”. With a median baseline NT-proBNP of 2343 ng/L, this is a high-risk cohort. The Jaccard index for overlap in worsening markers was low (0.18–0.31) before cardiac related hospitalization, but increased +0.8 prior to cardiac related death.
NT-proBNP and eGFR worsening were the markers most associated with HF hospitalisation (RR 2.81, p<0.001 – RR 2.59, p<0.002); 6MWT and KCCQ worsening were non-significant for all outcomes. However, worsening NT-proBNP seemed to preceed HF-related hospitalization, while eGFR followed.
Conclusion - In this cohort, clinial markers show no significant cohesion in their progression. With a Jaccard overlap of 0.17-0.37 indicating that 63-80% of patients with ATTR-CM show worsening in only one clinical marker. By the relative risk of hospitalization, NT-proBNP is the most reliable independent predictor of worsening condition, while eGFR can be assumed to be a response to cardio-renal decompensation.