Comparison of different techniques to identify cardiac involvement in immunoglobulin light chain (AL) amyloidosis

We retrospectively reviewed the utility of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and transthoracic echocardiogram (TTE) in diagnosing cardiac involvement in patients with biopsy-proven systemic immunoglobulin light chain amyloidosis seen at the Mayo Clinic between 1 January...

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Bibliographic Details
Published in:Blood advances 2019-04, Vol.3 (8), p.1226-1229
Main Authors: Aljama, Mohammed A., Sidiqi, M. Hasib, Dispenzieri, Angela, Gertz, Morie A., Lacy, Martha Q., Buadi, Francis K., Dingli, David, Muchtar, Eli, Fonder, Amie L., Hayman, Suzanne R., Hobbs, Miriam A., Gonsalves, Wilson I., Warsame, Rahma M., Kourelis, Taxiarchis, Hwa, Yi Lisa, Kapoor, Prashant, Leung, Nelson, Go, Ronald S., Kyle, Robert A., Rajkumar, S. Vincent, Kumar, Shaji K.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Echocardiography
Female
Heart Diseases - blood
Heart Diseases - diagnostic imaging
Heart Diseases - etiology
Heart Diseases - physiopathology
Humans
Immunoglobulin Light-chain Amyloidosis - blood
Immunoglobulin Light-chain Amyloidosis - complications
Immunoglobulin Light-chain Amyloidosis - diagnostic imaging
Immunoglobulin Light-chain Amyloidosis - physiopathology
Lymphoid Neoplasia
Male
Middle Aged
Natriuretic Peptide, Brain - blood
Peptide Fragments - blood
Retrospective Studies
Stroke Volume
Ventricular Function, Left
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Summary:We retrospectively reviewed the utility of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and transthoracic echocardiogram (TTE) in diagnosing cardiac involvement in patients with biopsy-proven systemic immunoglobulin light chain amyloidosis seen at the Mayo Clinic between 1 January 2006 and 30 December 2015. We analyzed 2 cohorts: patients undergoing endomyocardial biopsy for suspicion of cardiac involvement (cohort 1) and patients who had serum NT-proBNP and comprehensive echocardiographic evaluation at diagnosis (cohort 2). Of 179 patients undergoing endomyocardial biopsy (cohort 1), 173 (97%) had evidence of amyloid deposition, with 159 having NT-proBNP performed at the time of the procedure. The NT-proBNP was elevated (>300 pg/mL) in all 159 patients (sensitivity, 100%; median NT-proBNP, 4917 pg/mL; range, 355-69 541). The left ventricular ejection fraction, interventricular septal thickness, and strain rate were abnormal in 89/168 (53%), 102/64 (61%) and 92/95 (97%), respectively. Among cohort 2 (n = 342), 259 (76%) had an elevated NT-proBNP, of whom 237 (92%) had an abnormality detected on TTE. Of 83 patients with normal NT-proBNP
ISSN:2473-9529
2473-9537
DOI:10.1182/bloodadvances.2019032458