ESC Heart Failure (Jun 2022)

A simple staging system using biomarkers for wild‐type transthyretin amyloid cardiomyopathy in Japan

  • Naoya Nakashima,
  • Seiji Takashio,
  • Mami Morioka,
  • Masato Nishi,
  • Toshihiro Yamada,
  • Kyoko Hirakawa,
  • Masanobu Ishii,
  • Noriaki Tabata,
  • Kenshi Yamanaga,
  • Koichiro Fujisue,
  • Daisuke Sueta,
  • Hisanori Kanazawa,
  • Tadashi Hoshiyama,
  • Shinsuke Hanatani,
  • Satoshi Araki,
  • Hiroki Usuku,
  • Eiichiro Yamamoto,
  • Mitsuharu Ueda,
  • Kenichi Matsushita,
  • Kenichi Tsujita

DOI
https://doi.org/10.1002/ehf2.13847
Journal volume & issue
Vol. 9, no. 3
pp. 1731 – 1739

Abstract

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Abstract Aims It has been reported that a staging system combining N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity troponin T (hs‐cTnT) or estimated glomerular filtration rate (eGFR) is useful in patients with wild‐type transthyretin amyloid cardiomyopathy (ATTRwt‐CM). However, these studies were mainly conducted in Western countries, and their usefulness for the Japanese population is unclear. We examined and validated the staging system using hs‐cTnT, eGFR, and B‐type natriuretic peptide (BNP) in Japanese patients with ATTRwt‐CM. Methods and results We retrospectively evaluated 176 patients with ATTRwt‐CM. The cut‐off values of hs‐cTnT and eGFR were selected as 0.05 ng/mL and 45 mL/min/1.73 m2, respectively, based on a previous report. The optimal cut‐off value of BNP was 255.6 pg/mL to predict all‐cause mortality (sensitivity, 75%; specificity, 58%; area under the curve, 0.69; 95% confidence interval [CI], 0.61–0.78; P 0.05 ng/mL) and BNP (>250 pg/mL) and decreased eGFR (<45 mL/min/1.73 m2) were significant predictors of poor prognosis (P < 0.05). We calculated the score by adding 1 point if hs‐cTnT and BNP levels increased or eGFR decreased by more than the cut‐off value. The hazard ratio of all‐cause death adjusted by age and sex, using score 0 as a reference, was 0.44 (95% CI 0.08–2.49, P = 0.44) for score 1, 3.69 (95% CI 1.21–11.21, P = 0.02) for score 2, and 5.40 (95% CI 1.57–18.54, P = 0.007) for score 3. We divided patients into a low score group (0–1 point) and high score group (2–3 points). Kaplan–Meier analyses revealed significant differences in all‐cause death and rehospitalization for heart failure (log rank test; P < 0.001), and after adjusting for sex and age, the hazard ratio of all‐cause death was 6.96 (95% Cl 2.88–16.83, P < 0.001) and that for rehospitalization for heart failure was 4.27 (95% Cl 2.26–8.07, P < 0.001) in the high‐risk group, compared with those in the low‐risk group. The median survival period was 32.0 months in the high‐risk group. Conclusions This simple staging system, which combines hs‐cTnT, BNP, and eGFR, was useful for predicting prognosis in Japanese patients with ATTRwt‐CM. This system can objectively evaluate the disease progression of ATTRwt‐CM and may be useful for patient selection for disease‐modifying therapy.

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