ABSTRACT
BACKGROUND: In patients with transthyretin cardiac amyloidosis (ATTR-CA), renal dysfunction is a poor prognostic indicator. Limited data are available on variables that portend worsening renal function (wRF) among ATTR-CA patients. OBJECTIVES: This study assesses which characteristics place patients at higher risk for the development of wRF (defined as a drop of ≥10% in glomerular filtration rate [GFR]) within the first year following diagnosis of ATTR-CA. METHODS: We included patients with ATTR-CA (n = 134) evaluated between 2/2016 and 12/2022 and followed for up to 1 year at our amyloid clinic. Patients were stratified into two groups: a group with maintained renal function (mRF) and a group with wRF and compared using appropriate testing. Significant variables in the univariate analysis were included in the multivariable logistic regression model to determine characteristics associated with wRF. RESULTS: Within a follow-up period of 326 ± 118 days, the median GFR% change measured -6% [-18%, +8]. About 41.8% (n = 56) had wRF, while the remainder had mRF. In addition, in patients with no prior history of chronic kidney disease (CKD), 25.5% developed de novo CKD. On multivariable logistic regression, only New York Heart Association (NYHA) class ≥III (odds ratio [OR]: 3.9, 95% confidence interval [CI]: [1.6-9.3]), history of ischemic heart disease (IHD) (OR: 0.3, 95% CI: [0.1-0.7]), and not receiving SGLT-2i (OR: 0.1, 95% CI: [0.02-0.5]) were significant predictors of wRF. CONCLUSION: Our study demonstrated that the development of de novo renal dysfunction or wRF is common following the diagnosis of ATTR-CA. Additionally, we identified worse NYHA class and no prior history of IHD as significant predictors associated with developing wRF, while receiving SGLT-2i therapy appeared to be protective in this population.
Subject(s)
Amyloid Neuropathies, Familial , Cardiomyopathies , Glomerular Filtration Rate , Humans , Male , Female , Amyloid Neuropathies, Familial/complications , Amyloid Neuropathies, Familial/diagnosis , Amyloid Neuropathies, Familial/physiopathology , Aged , Cardiomyopathies/diagnosis , Cardiomyopathies/physiopathology , Cardiomyopathies/etiology , Prognosis , Retrospective Studies , Risk Factors , Middle Aged , Follow-Up Studies , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/epidemiology , Disease Progression , Kidney/physiopathology , Time Factors , Incidence , Risk Assessment/methodsABSTRACT
Background The first-line imaging for low to medium-risk patients presenting to the emergency department with stable chest pain is often a matter of debate. Chest pain is the second most common presentation to the emergency department. Non-invasive imaging has been useful in assisting in the diagnosis of coronary artery disease. Aim The aim of this study is to compare outcomes of Single Photon Emission Computed Tomography (SPECT) Nuclear Perfusion Stress and Coronary Computed Tomography Angiography (CCTA) performed in low to medium-risk patients and how they led to prolonged hospitalization and downstream testing. Materials and methods A total of 519 patients were selected for chart review using the following criteria: admitted for chest pain and older than 18 years of age. Those who presented with STEMI (ST-Elevation Myocardial Infarction) or non-(N)STEMI were excluded. Among these patients, four patients were excluded since their initial test was neither a CCTA nor SPECT Nuclear (NM) Perfusion Stress test. Another 30 patients were excluded based on HEART score (a clinical tool to stratify the risk of major adverse cardiac events) >7 and 111 patients with estimated glomerular filtration rate (eGFR) <60 were excluded. A total of 374 patients underwent analysis. Results Univariate data analysis of 374 patients demonstrated a higher percentage of patients with HEART scores 0-3 underwent CCTA (51.6% vs. 31.8% p=0.0250) when compared to patients with SPECT NM perfusion. Multivariable logistic regression revealed that the difference in length of stay between SPECT NM perfusion stress and CCTA was significant, patients with the CCTA test were less likely to have a length of stay ≥24 hours (odds ratio {OR}=0.41, p=0.0465) compared to patients with NM perfusion stress test. Conclusion This retrospective cohort study demonstrated that patients who underwent CCTA upon chest pain admission were more likely to have a decreased length of stay time to less than 24 hours.
