Right Ventricular to Pulmonary Artery Uncoupling Is Associated With Impaired Exercise Capacity in Patients With Transthyretin Cardiac Amyloidosis
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- Hashimoto Toru
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Ikuta Kei
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Yamamoto Shoei
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Yoshitake Tomoaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Suenaga Tomoyasu
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Nakashima Shunsuke
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Kai Takashi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Misumi Kayo
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Fujino Takeo
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Department of Advanced Cardiopulmonary Failure, Faculty of Medical Sciences, Kyushu University
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- Shinohara Keisuke
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Matsushima Shouji
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Atsumi Rina
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital
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- Isoda Takuro
- Department of Clinical Radiology, Faculty of Medical Sciences, Kyushu University
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- Kinugawa Shintaro
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Abe Kohtaro
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
Description
<p>Background: Exercise capacity is related to mortality and morbidity in heart failure (HF) patients. Determinants of exercise capacity in transthyretin cardiac amyloidosis (ATTR-CA) have not been established.</p><p>Methods and Results: This single-center study retrospectively evaluated ATTR-CA patients and patients with non-amyloidosis HF with preserved/mildly reduced ejection fraction (HFpEF/HFmrEF) (n=32 and n=51, respectively). In the ATTR-CA group, the median age was 75.5 years (interquartile range [IQR] 71.3–78.8 years), 90.6% were male, and the median left ventricular (LV) ejection fraction was 53.5% (IQR 41.4–65.6%). Cardiopulmonary exercise tests revealed a median peak oxygen consumption and anaerobic threshold of 15.9 (IQR 11.6–17.4) and 10.6 (IQR 8.5–12.0] mL/min/kg, respectively, and ventilatory efficiency (minute ventilation/carbon dioxide production [V̇E/V̇CO2] slope) of 35.5 (IQR 32.0–42.5). Among exercise variables, V̇E/V̇CO2slope has the greatest prognostic value. Univariate analysis revealed a significant correlation between V̇E/V̇CO2slope and age, LV global longitudinal strain, tricuspid annular plain systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio, and mixed venous oxygen saturation. In multivariate analyses, the TAPSE/PASP ratio was an independent predictor of V̇E/V̇CO2slope (95% confidence interval −44.5, −10.8; P=0.0067). In non-amyloidosis HFpEF/HFmrEF patients, the TAPSE/PASP ratio was not independently correlated with V̇E/V̇CO2slope.</p><p>Conclusions: Right ventricular–pulmonary artery coupling estimated by the TAPSE/PASP ratio determines exercise capacity in ATTR-CA patients. This highlights the importance of early therapeutic intervention against underappreciated right ventricular dysfunction associated with ATTR-CA.</p>
Journal
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- Circulation Journal
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Circulation Journal 89 (1), 31-40, 2024-12-25
The Japanese Circulation Society