Aims Although systemic embolism is a potential complication in transthyretin amyloid cardiomyopathy (ATTR-CM), data about its incidence and prevalence are scarce. We studied the incidence, prevalence and factors associated with embolic events in ATTR-CM. Additionally, we evaluated embolic events according to the type of oral anticoagulation (OAC) and the performance of the CHA(2)DS(2)-VASc score in this setting. Methods and results Clinical characteristics, history of atrial fibrillation (AF) and embolic events were retrospectively collected from ATTR-CM patients evaluated at four international amyloid centres. Overall, 1191 ATTR-CM patients (87% men, median age 77.1 years [interquartile range-IQR 71.4-82], 83% ATTRwt) were studied. A total of 162 (13.6%) have had an embolic event before initial evaluation. Over a median follow-up of 19.9 months (IQR 9.9-35.5), 41 additional patients (3.44%) had an embolic event. Incidence rate (per 100 patient-years) was 0 among patients in sinus rhythm with OAC, 1.3 in sinus rhythm without OAC, 1.7 in AF with OAC, and 4.8 in AF without OAC. CHA(2)DS(2)-VASc did not predict embolic events in patients in sinus rhythm whereas in patients with AF without OAC, only those with a score >= 4 had embolic events. There was no difference in the incidence rate of embolism between patients with AF treated with vitamin K antagonists (VKAs) (n = 322) and those treated with direct oral anticoagulants (DOACs) (n = 239) (p = 0.66). Conclusions Embolic events were a frequent complication in ATTR-CM. OAC reduced the risk of systemic embolism. Embolic rates did not differ with VKAs and DOACs. The CHA(2)DS(2)-VASc score did not correlate well with clinical outcome in ATTR-CM and should not be used to assess thromboembolic risk in this population.
Systemic embolism in amyloid transthyretin cardiomyopathy / Vilches, Silvia; Fontana, Marianna; Gonzalez‐Lopez, Esther; Mitrani, Lindsey; Saturi, Giulia; Renju, Mary; Griffin, Jan M.; Caponetti, Angelo; Gnanasampanthan, Sahana; De los Santos, Jeffeny; Gagliardi, Christian; Rivas, Adrian; Dominguez, Fernando; Longhi, Simone; Rapezzi, Claudio; Maurer, Mathew S.; Gillmore, Julian; Garcia‐Pavia, Pablo. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1388-9842. - STAMPA. - 24:8(2022), pp. 1387-1396. [10.1002/ejhf.2566]
Systemic embolism in amyloid transthyretin cardiomyopathy
Fontana, Marianna;Saturi, Giulia;Caponetti, Angelo;Gagliardi, Christian;Dominguez, Fernando;Longhi, Simone;Rapezzi, Claudio;
2022
Abstract
Aims Although systemic embolism is a potential complication in transthyretin amyloid cardiomyopathy (ATTR-CM), data about its incidence and prevalence are scarce. We studied the incidence, prevalence and factors associated with embolic events in ATTR-CM. Additionally, we evaluated embolic events according to the type of oral anticoagulation (OAC) and the performance of the CHA(2)DS(2)-VASc score in this setting. Methods and results Clinical characteristics, history of atrial fibrillation (AF) and embolic events were retrospectively collected from ATTR-CM patients evaluated at four international amyloid centres. Overall, 1191 ATTR-CM patients (87% men, median age 77.1 years [interquartile range-IQR 71.4-82], 83% ATTRwt) were studied. A total of 162 (13.6%) have had an embolic event before initial evaluation. Over a median follow-up of 19.9 months (IQR 9.9-35.5), 41 additional patients (3.44%) had an embolic event. Incidence rate (per 100 patient-years) was 0 among patients in sinus rhythm with OAC, 1.3 in sinus rhythm without OAC, 1.7 in AF with OAC, and 4.8 in AF without OAC. CHA(2)DS(2)-VASc did not predict embolic events in patients in sinus rhythm whereas in patients with AF without OAC, only those with a score >= 4 had embolic events. There was no difference in the incidence rate of embolism between patients with AF treated with vitamin K antagonists (VKAs) (n = 322) and those treated with direct oral anticoagulants (DOACs) (n = 239) (p = 0.66). Conclusions Embolic events were a frequent complication in ATTR-CM. OAC reduced the risk of systemic embolism. Embolic rates did not differ with VKAs and DOACs. The CHA(2)DS(2)-VASc score did not correlate well with clinical outcome in ATTR-CM and should not be used to assess thromboembolic risk in this population.File | Dimensione | Formato | |
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