2026-07-22T04:44:31Zhttps://repisalud.isciii.es/rest/oai/requestoai:repisalud.isciii.es:20.500.12105/258952025-12-18T12:55:55Zcom_20.500.12105_19604com_20.500.12105_2051col_20.500.12105_19605
Repisalud
author
Witteles, Ronald
author
Jefferies, John L
author
Kapa, Suraj
author
Cappelli, Francesco
author
Sultan, Marla B
author
Gundapaneni, Balarama
author
Davis, Margot K
author
Garcia-Pavia, Pablo
2024-12-17T13:34:26Z
2024-12-17T13:34:26Z
2024-08
JACC CardioOncol. 2024 Apr 30;6(4):592-598.
39239341
https://hdl.handle.net/20.500.12105/25895
Atrial fibrillation/atrial flutter (AF/AFL) are common manifestations of transthyretin amyloid cardiomyopathy (ATTR-CM) but have not been found to be predictive of mortality. This analysis aimed to examine whether baseline or historical AF/AFL at enrollment was prognostic for all-cause mortality. In the ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial), a 30-month study of tafamidis vs placebo for ATTR-CM, AF/AFL was evaluated as an independent prognostic factor for all-cause mortality using Cox proportional hazards modelling. The impact of AF/AFL on tafamidis efficacy was explored by adding an interaction term for AF/AFL status and treatment. ATTR-ACT enrolled 441 patients with ATTR-CM (median age 75 years; 90% male); 314 (71.2%) had baseline or historical AF/AFL at enrollment. AF/AFL was an independent prognostic factor for all-cause mortality after adjusting for covariates prespecified in the ATTR-ACT model (treatment, genotype, New York Heart Association functional class; HR: 0.550; 95% CI: 0.368-0.821) but not in an expanded stepwise model selection analysis including 23 covariates (blood urea nitrogen and N-terminal pro-B-type natriuretic peptide concentration, 6-minute walk test distance, genotype, treatment, and global longitudinal strain were prognostic [ < 0.01]). The interactions between tafamidis treatment and AF/AFL for all-cause mortality ( = 0.33) and changes in Kansas City Cardiomyopathy Questionnaire Overall Summary score ( = 0.83) and 6-minute walk test distance ( = 0.82) were not significant. In ATTR-ACT, baseline or historical AF/AFL was prognostic for all-cause mortality in analyses with limited adjustment but not after accounting for additional indicators of disease severity. Baseline or historical AF/AFL did not impact the efficacy of tafamidis treatment. (Safety and Efficacy of Tafamidis in Patients With Transthyretin Cardiomyopathy [ATTR-ACT]; NCT01994889).
eng
amyloidosis
arrhythmia
cardiomyopathy
heart failure
Atrial Fibrillation as a Prognostic Factor for All-Cause Mortality in Patients With Transthyretin Amyloid Cardiomyopathy.
research article
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c3029249012b94197a7fc73003b9e324
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Atrial Fibrillation_JACC CardioOncol_2024.pdf