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Association of an ATTR cardiomyopathy risk score with cardiac and kidney outcomes among patients with chronic kidney disease - Insights from CRIC
Session:
SESSÃO DE POSTERS 04 - AMILOIDOSE E AORTA
Speaker:
Catarina Vale
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.7 Chronic Heart Failure - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Catarina Vale; Muthiah Vaduganathan; Brendon L. Neuen; João S. Neves; Scott D. Solomon; Finnian R. Mc Causland
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Transthyretin amyloid cardiomyopathy (ATTR-CM) is thought to be an underdiagnosed cause of heart failure, especially among those with HF with preserved ejection fraction (HFpEF). A clinical risk-score to predict ATTR-CM has been validated among patients with HFpEF, but its utility among patients with chronic kidney disease is unclear. </span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">We applied a 6-variable risk score (age, sex, hypertension, ejection fraction, relative wall thickness, posterior wall thickness; range -1 to +10) to participants of the Chronic Renal Insufficiency Cohort with available 1-year echocardiographic data (n=2,718) and calculated the prevalence of a high-risk score (6 points). Using Cox regression models, landmarked at 1-year, we explored the adjusted association of a high vs. low-risk score with development of atrial fibrillation (AF), HF, stroke, myocardial infarction (MI), a kidney composite (kidney failure, ≥ 50% decline in estimated glomerular filtration rate (eGFR), eGFR15 mL/min/1.73 m<sup>2</sup>), and all-cause mortality.</span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">The median score was 4 [2, 5]; 539 (19.8%) had a high-risk score for ATTR-CM, which was associated with a higher adjusted risk of AF (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.48, 2.35), HF (HR 1.63, 95%CI 1.27, 2.08), MI (HR 1.82, 95%CI 1.33, 2.49) and all-cause mortality (HR 1.60, 95%CI 1.37, 1.87). There was a trend towards a higher risk of stroke with high (vs low) risk score (HR 1.47, 95%CI 0.94, 2.29) but no association with kidney composite (HR 1.01, 95%CI 0.82, 1.23). Using a restricted cubic spline, a monotonic association of higher risk score with all-cause mortality was evident (Figure 1). </span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">1 in 5 individuals with CKD in CRIC appear to have a high predicted risk for ATTR-CM. A high-risk score was prognostic for adverse cardiac outcomes and death, but not for a kidney composite outcome. Future studies to examine the true prevalence and to determine the optimal screening pathways for ATTR-CM among patients with CKD are warranted. </span></span></span></p>
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