Associated diseases and diuretic dosage to predict mortality in transthyretin amyloid cardiomyopathy - 08/05/26
, Olivier Lairez b, m, Marion Narbeburu c, Pauline Fournier b, Jerome Costa d, Francoise Pelcot e, Agnes Farrugia e, Isabelle Durand-Zaleski f, Herve Lilliu g, Mathilde Bartoli h, Stephane Fievez h, Jeremie Rudant h, Agathe Coste h, Charlotte Noirot Cosson h, Pierre Alexandre Squara h, Giorgia Canali h, Bertrand de Neuville c, Michel S. Slama a, Philippe Charron i, j, Thibaud Damy k, l, mGraphical abstract |
Highlights |
• | This French nationwide study included 7804 patients with ATTR-CM during 2011–2019. |
• | Comorbidities were common, including kidney disease (37.0%) and diabetes (29.5%). |
• | Diuretic dose (a proxy for congestion severity) was associated with mortality (HR 1.38). |
• | Median survival decreased from 6.6 to 1.5 years in patients on < 20 to ≥ 120 mg/day furosemide. |
• | Age, sex, diuretic dose, heart failure and kidney disease independently predicted mortality. |
Abstract |
Background |
Transthyretin amyloidosis can lead to transthyretin amyloid cardiomyopathy (ATTR-CM) and heart failure.
Aims |
To describe the prevalence of cardiac and extracardiac diseases in patients with ATTR-CM and examine mortality predictors, including diuretic dosage, using the French National Health Database.
Methods |
Patients with ATTR-CM and their medical characteristics were identified from the French database from 2011 to 2019. Diuretic doses were categorized into four classes (furosemide dose: level 1 < 20 mg; level 2 20 to < 60 mg; level 3 60 to < 120 mg; level 4 ≥ 120 mg). Predictive factors for mortality were examined.
Results |
Of 7804 patients with ATTR-CM, 33.0% were on level 1 diuretics, 25.8% on level 2, 15.8% on level 3 and 25.3% on level 4 at diagnosis. Leading extracardiac conditions included kidney disease (37.0%), diabetes (29.5%), neurologic disorders (17.9%), gastrointestinal disorders (15.7%) and musculoskeletal conditions (11.8%). Median (95% confidence interval [CI]) survival was 3.1 (3.0–3.3) years. Multivariable analysis identified age at diagnosis (hazard ratio [HR] 1.482, 95% CI 1.400–1.558), male sex (HR 1.258, 95% CI 1.125–1.406), diuretic dose (HR 1.380, 95% CI 1.315–1.449), heart failure (HR 1.251, 95% CI 1.090–1.437), arrhythmia/conduction disorder (HR 1.143, 95% CI 1.001–1.306), kidney disease (HR 1.224, 95% CI 1.104–1.358), gastrointestinal disorder (HR 1.143, 95% CI 1.000–1.307) and diabetes (HR 1.192, 95% CI 1.071–1.326) as significantly associated with mortality.
Conclusion |
Patients with ATTR-CM face a significant burden of associated diseases requiring comprehensive management alongside their ATTR-CM treatment. Beyond addressing these comorbidities, diuretic dosage emerges as a pivotal prognostic indicator.
Le texte complet de cet article est disponible en PDF.Keywords : Amyloidosis, Comorbidities, Heart failure, Survival, Transthyretin
Abbreviations : ALD, ATTR, ATTR-CM, CCAM, CI, ICD-10, IQR, SNDS
Plan
Vol 119 - N° 5
P. 341-347 - mai 2026 Retour au numéro
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