Effects of Patisiran, an RNA Interference Therapeutic, on Regional Left Ventricular Myocardial Deformation in Hereditary Transthyretin Amyloidosis: The APOLLO Study - 07/06/19
Résumé |
Introduction |
Cardiac amyloidosis patients demonstrate reduced myocardial strain with relative sparing of the cardiac apex. in APOLLO patisiran reduced NT-proBNP and left ventricular (LV) wall thickness and improved global longitudinal strain (GLS) relative to PBO in patients with hereditary transthyretin mediated (hATTR) amyloidosis.
Method |
An exploratory analysis from APOLLO, a randomized double-blind, PBO-controlled Ph3 trial in h ATTR amyloidosis with polyneuropathy, assessed effects of patisiran on LV regional strain. Patients were randomized 2:1 to receive 0.3mg/kg patisiran or PBO via IV infusion once every 3 weeks for 18 months. The prespecified cardiac subpopulation (n=126) comprised patients with baseline LV wall thickness ≥ 13mm and no history of hypertension or aortic valve disease. Patient underwent two-dimensional and speckle tracking echocardiography.
Results |
At baseline, average strain was lowest in the basal segments with apical sparing. Patisiran reduced GLS (LSM difference±SE;−1.36±0.56%, P=0.014) compared with PBO at 18 months, with the greatest reduction in LV strain was observed in the basal region, (overall LSM difference−2.08±0.75%, P=0.006), and no significant differences in the mid and apical regions among groups (Figure 1).
Conclusion |
Patisiran improved LV GLS driven primarily by improvements in the basal region, suggesting that basal regional longitudinal strain may be a more sensitive marker to evaluate treatments for the cardiomyopathy in hATTR amyloidosis (Figure 1: Least-squares mean change in LV longitudinal strain from baseline at 18 months).
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Vol 11 - N° 3
P. e319-e320 - juin 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.