Incremental Value of Global Longitudinal Strain for Predicting Survival in Patients With Advanced AL Amyloidosis

Katherine Lee Chuy, MD; Esther Drill, DrPH; Ji Can Yang, DO; Heather Landau, MD; Hani Hassoun, MD; Omar Nahhas, MD; Carol L. Chen, MD; Anthony F. Yu, MD; Richard M. Steingart, MD; Jennifer E. Liu, MD

JACC. CardioOncology (Jun 2020)

Incremental Value of Global Longitudinal Strain for Predicting Survival in Patients With Advanced AL Amyloidosis

Katherine Lee Chuy, MD,
Esther Drill, DrPH,
Ji Can Yang, DO,
Heather Landau, MD,
Hani Hassoun, MD,
Omar Nahhas, MD,
Carol L. Chen, MD,
Anthony F. Yu, MD,
Richard M. Steingart, MD,
Jennifer E. Liu, MD

Affiliations

Katherine Lee Chuy, MD: Department of Cardiology, Cook County Health, Chicago, Illinois, USA
Esther Drill, DrPH: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Ji Can Yang, DO: New York Presbyterian–Brooklyn Methodist Hospital, New York, New York, USA
Heather Landau, MD: Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA
Hani Hassoun, MD: Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Omar Nahhas, MD: Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Carol L. Chen, MD: Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Anthony F. Yu, MD: Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Richard M. Steingart, MD: Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Jennifer E. Liu, MD: Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Address for correspondence: Dr. Jennifer E. Liu, Department of Medicine, Weill Cornell Medical College, 1275 York Avenue, New York, New York 10065.

Journal volume & issue: Vol. 2, no. 2
pp. 223 – 231

Abstract

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Background: Advanced light-chain (AL) amyloidosis is associated with poor prognosis, with a 5-year survival rate of <25%. Prognostication is based on the revised Mayo (rMayo) staging according to serum cardiac biomarkers. Objectives: This study sought to determine whether global longitudinal strain (GLS) can provide incremental prognostic value in patients with advanced disease. Methods: Baseline (pre-treatment) clinical, 2-dimensional echocardiogram with GLS and laboratory data were collected prospectively in 94 patients with newly diagnosed AL amyloidosis with rMayo stage III or IV disease. Overall survival (OS) was defined as time from baseline echocardiography to death. Results: Of 94 patients, 60% (n = 56) had rMayo stage III and 40% (n = 38) had stage IV disease. Ninety of the 94 patients underwent plasma cell-directed therapy. The median left ventricular ejection fraction (LVEF) was 60%, and the median GLS was 13.2%. Of 94 patients, 64 died during follow-up. The median OS was 11.2 months, with an estimated 5-year OS of 21%. In univariable analysis, brain natriuretic peptides, GLS, LVEF, E/e′ ratio, and rMayo stage were significantly associated with OS. In Cox regression, GLS provided incremental value over brain natriuretic peptide, troponin, and LVEF for predicting OS. Patients with GLS < –14.2% had a corresponding median OS and 5-year OS rate of 33.2 months and 39%, respectively, versus 7.7 months and 6% for those with GLS ≥ –14.2%. This difference was maintained despite further stratification by rMayo stage. Conclusions: Baseline GLS is an independent predictor of OS beyond the circulating biomarkers and can identify groups with different survival outcomes beyond the Mayo Staging.

Published in JACC. CardioOncology

ISSN: 2666-0873 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jacc-cardiooncology

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