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Título
Systemic embolism in amyloid transthyretin cardiomyopathy.
Autor(es)
Vilches, Silvia | Fontana, Marianna | Gonzalez-Lopez, Esther CNIC | Mitrani, Lindsey | Saturi, Giulia | Renju, Mary | Griffin, Jan M | Caponetti, Angelo | Gnanasampanthan, Sahana | De Los Santos, Jeffeny | Gagliardi, Christian | Rivas, Adrian | Dominguez, Fernando CNIC | Longhi, Simone | Rapezzi, Claudio | Maurer, Mathew S | Gillmore, Julian | Garcia-Pavia, Pablo CNIC
Fecha de publicación
2022-08
Cita
Eur J Heart Fail. 2022 Aug;24(8):1387-1396
Idioma
Inglés
Tipo de documento
journal article
Resumen
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 CHA2 DS2 -VASc score in this setting.
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. CHA2 DS2 -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).
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 CHA2 DS2 -VASc score did not correlate well with clinical outcome in ATTR-CM and should not be used to assess thromboembolic risk in this population.
MESH
Atrial Fibrillation | Cardiomyopathies | Embolism | Heart Failure | Stroke | Aged | Anticoagulants | Female | Fibrinolytic Agents | Humans | Male | Prealbumin | Retrospective Studies | Risk Assessment | Risk Factors
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