Prevalence and prognostic value of small fiber neuropathy assessed by Sudoscan ® in transthyretin wild-type cardiac amyloidosis - 09/01/21
, F. Roche 3, 4, M. Bézard 1, 2, D. Hupin 3, 4, S. Silva 1, S. Oghina 1, 5, C. Chalard 1, 5, A. Zaroui 1, 6, A. Galat 1, 5, S. Guendouz 1, 5, F. Canoui Poitrine 7, V. Planté-Bordeneuve 5, 8, L. Hittinger 1, 5, E. Teiger 1, 5, J.P. Le Faucheur 9, 8, T. Damy 1, 5
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Résumé |
Background |
The prevalence of small-fiber neuropathy (SFN) is high in patients with hereditary transthyretin amyloidosis (ATTRv) but remains unknown in transthyretin wild-type cardiac amyloidosis (ATTRwt-CA).
Objective |
To determine the prevalence of SFN in patients with ATTRwt-CA using Sudoscan®, a non-invasive method used to provide evidence of SFN in clinical practice and based on measurement of electrochemical skin conductance at the hands (hESC) and feet (fESC).
Methods |
A series of 62 non-diabetic patients with ATTRwt-CA was prospectively included over 2 years and compared to healthy elderly subjects, matched on age, gender and body mass index. The presence of SFN was defined as hESC <60μS and/or fESC <70μS and conductances were analyzed according to clinical, biological, and echocardiographic data.
Results |
Mean hESC and fESC were significantly lower in patients with ATTRwt-CA than in elderly controls: 61.5 vs. 70.0μS (P=0.006) and 68.3 vs. 76.9μS respectively (P<0.0001). Prevalence of hESC<60μS and fESC <70μS was higher in patients with ATTRwt-CA than in controls: 33.9% versus 16.7% and 48.4% versus 19.9%, P<0.05. Univariate analysis showed that fESC, NT-proBNP, creatinine plasma levels, and echocardiographic global longitudinal strain were associated with decompensated cardiac failure and death. Multivariate analysis revealed that fESC was an independent prognostic factor and Kaplan-Meier estimator evidenced a larger occurrence of cardiac decompensation and death in patients with fESC<70μS, P=0.046.
Conclusion |
A reduced fESC was observed in almost 50% of patients with ATTRwt-CA and was associated with a worse prognosis. Sudoscan® could be used easily to screen ATTRwt-CA patients for the presence of SFN and identify patients at higher risk of outcome.
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Vol 13 - N° 1
P. 29 - janvier 2021 Retour au numéro
Article précédent
- Frailty in ATTRwt Cardiac Amyloidosis: The hidden part of the iceberg
- A. Broussier, J.P. David, M. Kharoubi, S. Oghina, L. Segaux, E. Teiger, M. Laurent, I. Fromentin, T. Damy, S. Bastuji
- Prevalence and type of first amyloid extracardiac symptoms and cardiac disorders history and time from their occurrence to diagnosis between Al and transthyretin cardiac amyloidosis
- M. Kharoubi, M. Bézard, A. Galat, F. Le Bras, E. Poullot, L. Hittinger, V. Moulinier Frenkel, P. Fanen, B. Funalot, A. Moktefi, J.P. Le Faucheur, A. Mukedaisi, J. Deux, T. Gendre, V. Audard, E. Audureau, E. Bequignon, V. Plante, S. Oghina, T. Damy
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