Abstract

Background

Intracardiac thrombosis is reported to occur frequently in cardiac amyloidosis (CA). However, data regarding arterial thrombo-embolic events (AEs) in CA are limited. We aimed at assessing prevalence, clinical characteristics and predictors of AEs in a large multicentric CA cohort.

Methods and results

Four-hundred-six consecutive CA patients (134 AL, 73 ATTRm and 199 ATTRwt) from 5 Italian referral centres were retrospectively evaluated and followed-up for a median time of 19 months. Thirty-one patients (7.6%) suffered from an AE, of whom 10 (32.2%) were in sinus rhythm and had no history of AF. There were no significant differences in terms of age, gender and type of CA between patients with or without AEs. Fourteen (7.6%) of 185 patients on anticoagulation had an AE despite therapy. Anticoagulation therapy did not appear to fully protect from the risk of events (HR 1.23, 95%CI 0.52–2.92, p = .64). The only predictor of AEs, in particular among CA patients in sinus rhythm, was a CHA2DS2-VASC score ≥ 3 (HR 2.84, 95%CI 1.02–7.92, p = .05 in overall population; HR 10.13, 95%CI 1.12–91.19, p = .04 in patients in sinus rhythm).

Conclusions

In our large, multicentric, real-world cohort, prevalence and incidence rate of AEs was high. A consistent proportion of events occurred despite anticoagulation therapy or in patients in sinus rhythm. A higher CHA2DS2-VASc score might identify patients at risk of AEs also among those in sinus rhythm.

中文翻译：

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心脏淀粉样变性中的动脉血栓栓塞事件：超越心房颤动的展望

摘要

背景

据报道，心脏淀粉样变性（CA）中经常发生心内血栓形成。然而，关于 CA 中动脉血栓栓塞事件 (AE) 的数据有限。我们旨在评估大型多中心 CA 队列中 AE 的患病率、临床特征和预测因素。

方法和结果

对来自 5 个意大利转诊中心的 466 名连续 CA 患者（134 名 AL、73 名 ATTRm 和 199 名 ATTRwt）进行了回顾性评估和中位时间 19 个月的随访。31 名患者 (7.6%) 出现 AE，其中 10 名 (32.2%) 为窦性心律且无 AF 病史。有或没有 AE 的患者在年龄、性别和 CA 类型方面没有显着差异。185 名接受抗凝治疗的患者中有 14 名 (7.6%) 尽管接受了治疗，但仍有 AE。抗凝治疗似乎不能完全避免事件风险（HR 1.23, 95%CI 0.52–2.92, p  = .64）。AE 的唯一预测因素，特别是在窦性心律的 CA 患者中，是 CHA2DS2-VASC 评分 ≥ 3 (HR 2.84, 95%CI 1.02–7.92, p = .05 总人口；HR 10.13, 95%CI 1.12–91.19, p  = .04（窦性心律患者）。

结论

在我们的大型、多中心、真实世界队列中，AE 的患病率和发病率很高。尽管进行了抗凝治疗或在窦性心律的患者中发生了一致比例的事件。较高的 CHA2DS2-VASc 评分可能会在窦性心律患者中识别出有 AE 风险的患者。