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Prognostic Value of Nutritional and Functional Status in patients with ATTR-CM: insights from a tertiary referral center
Session:
Sessão de Posters 42 - Para além da hipertrofia: as faces ocultas da doença miocárdica
Speaker:
Maria Inês Vicente Soares
Congress:
CPC 2026
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.14 Cardiovascular Disease in Special Populations - Other
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Maria Inês Vicente Soares; Rita Almeida Carvalho; Rui Gomes; Débora Correia; Rita Amador; Tânia Laranjeira; Carlos Aguiar; Sérgio Maltês; Bruno Rocha
Abstract
<p>Background: Nutritional and performance status assessed by serum albumin and Clinical Frailty Scale (CFS) are well-recognized prognostic markers in patients with Heart Failure (HF). Their added value in transthyretin cardiac amyloidosis (ATTR-CM) relative to other well-established markers remains to be further elucidated. </p> <p>Aim: To evaluate the prognostic impact of serum albumin and frailty in ATTR-CM. </p> <p>Methods: All consecutive patients diagnosed with ATTR-CM followed in our center from 2019-2025 were included. As per site protocol, serum albumin and CFS are systematically measured at the time of diagnosis, and made available in the electronic chart. The primary endpoint was a composite of all-cause death or first hospitalization for HF. Optimal cutoff values were determined by ROC curve analysis. Kaplan–Meier curves were generated to estimate event-free survival. Univariate and multivariable logistic regression model was then performed, adjusting for clinically relevant variables. </p> <p>Results: A total of 279 patients were included (82% male; mean age: 83 ± 7 years; 62% on tafamidis; median serum albumin 3.8 [3.5–4.0] g/dL; median CFS 3 [2-4]). ROC curve analysis identified albumin <3.7 g/dL and CFS >3 as the optimal cutoffs (sensitivity 49% and 68%, and specificity 54% and 94%, respectively). </p> <p>Patients with serum albumin <3.7g/dL had significantly worse NYHA (III-IV: 32 vs. 15%; p=0.004) and higher NT-proBNP (3359 vs. 2140 pg/mL; p=0.004). Likewise, those with a CFS >3 were more likely to have worse NYHA (III-IV: 38 vs. 17%; p=0.001) and higher NT-proBNP (5718 vs. 2140 pg/mL; p=0.002), and presented with a higher prevalence of atrial fibrillation (85 vs. 63%; p=0.003), lower serum albumin (3.6 vs. 3,8 g/dL; p=0.021), and more often with persistent peripheral congestion (59 vs. 39%; p=0.01) and combined diuretic therapy with mineralocorticoid receptor antagonists (52 vs. 35%; p=0.023). </p> <p>In multivariable logistic regression (adjusted for age, left ventricular ejection fraction, NT-proBNP, NYHA, and tafamidis therapy), both albumin (HR 0.22; 95% CI 0.09–0.54; p=0.001) and CSF (HR 1.43; 95% CI 1.03–1.98; p=0.032) were independently associated with the primary outcome. Moreover, both markers predicted adverse events consistently across age groups, disease stages, and tafamidis treatment status (central figure). </p> <p>Conclusion: We found that serum albumin and CFS were independently associated with a higher incidence of all-cause mortality or HF hospitalization in ATTR-CM. These easily obtainable clinical measures underscore the importance of incorporating nutritional and functional status assessment as part of the routine risk stratification strategy, adding value beyond traditional cardiovascular parameters.</p>
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