PROSPECTIVE EVALUATION OF PROGNOSTIC AND PATHOPHYSIOLOGIC IMPLICATIONS OF BLOOD PRESSURE MONITORING AND BARORECEPTOR REFLEX SENSITIVITY (BRS) IN PATIENTS WITH AL AMYLOIDOSIS
(Abstract release date: 05/19/16)
EHA Library. Kastritis E. 06/09/16; 132855; E1306
Dr. Efstathios Kastritis
Contributions
Contributions
Abstract
Abstract: E1306
Type: Eposter Presentation
Background
cardiac dysfunction is the major determinant of prognosis in patients with AL amyloidosis. Elevated levels of cardiac biomarkers (troponin and of NTproBNP) identify patients at high risk (stage 3 per Mayo stage) but low blood pressure (BP) is independently associated with poor prognosis especially in patients with Mayo stage-3 disease (Wechalekar et al Blood 2013). Cardiac output and autonomic nervous system (ANS) are major regulators of BP and both are affected in AL amyloidosis.
Aims
to prospectively evaluate the prognostic role of BP by using standard and 24 hour BP measurements and evaluate the importance of the deregulation of ANS in AL amyloidosis by assessing Baroreceptor reflex sensitivity (BRS).
Methods
Newly diagnosed patients, with biopsy confirmed AL amyloidosis, were prospectively evaluated. All patients underwent standard office BP office BP measurements (three BP measurements taken at a 1-min intervals, at sitting position, averaged to obtain a single systolic and diastolic office BP value), 24h ambulatory BP monitoring and a simultaneously electrocardiographic and non-invasive BP monitoring (Finometer), under standardized conditions for 15 min. Ambulatory BP monitoring was performed on a usual working day. BP recordings were obtained automatically at 15-min intervals throughout the 24h period. BRS was expressed as the alpha-index (a-index), which was estimated by means of power spectral analysis.
Results
we evaluated 68 consecutive patients (median age 65, range 40-84 years, 50% males). Heart was involved in 65%, kidneys in 70% and nervous system in 23%, while 10% were Mayo stage-1, 60% stage-2 and 30% stage-3 and 14% had NTproBNP≥8500 ng/L. Median eGFR was 63 ml/min/1.73 m2. Primary treatment was bortezomib-based (VD, VCD or BMDex) in 80% and MDex in 20%. Median office systolic BP (SBP) was 118 mmHg and median diastolic BP (DBP) was 72 mmHg. SBP was lower in stage 2 vs stage 1 and stage 3 vs either stage 2 or stage 1 patients (p=0.026) but there was no difference in the DBP between groups. The median of mean 24h ambulatory SBP was 112.5 mmHg and for DBP was 69.5 mmHg. Advanced Mayo stage was associated with lower mean 24h SBP (p=0.048). None of the patients with Mayo stage 1, 13% of those with stage-2 and 33% of those with stage-3 had office SBP<100 mmHg. For 24h mean SBP, none with stage 1, 23% with stage 2 and 42% with stage 3 had mean ambulatory SBP<100 mmHg. Lower levels of SBP were associated with inferior survival: either office SBP <100 mmHg (6 months vs not reached) (p<0.001) or mean 24h SBP<90 mmHg (2 months vs not reached) (p<0.001) were associated with poor survival and early death. Further analysis of 24h ambulatory BP recordings indicated higher BP fluctuations among patients with less severe or no heart involvement, while more often patients with Mayo stage 3 had higher nighttime vs daytime SBP values than stage 2 or stage 1 patients. Median a-index was 2.85 (range 0.4-5.85) but it was lower in patients with advanced cardiac involvement and was also lower in patients who had nerve involvement (median 1.6 vs 3.3, p=0.016), reflecting both cardiac and nerve involvement by AL amyloidosis. In addition, low a-index was associated with early death.
Conclusion
Low BP, either measured in a sitting position as in standard office visits or by means of 24h ambulatory measurement, is associated with poor prognosis in patients with AL amyloidosis. Impaired BRS is associated with advanced cardiac and nerve involvement and risk of early death.
Session topic: E-poster
Keyword(s): Amyloidosis
Type: Eposter Presentation
Background
cardiac dysfunction is the major determinant of prognosis in patients with AL amyloidosis. Elevated levels of cardiac biomarkers (troponin and of NTproBNP) identify patients at high risk (stage 3 per Mayo stage) but low blood pressure (BP) is independently associated with poor prognosis especially in patients with Mayo stage-3 disease (Wechalekar et al Blood 2013). Cardiac output and autonomic nervous system (ANS) are major regulators of BP and both are affected in AL amyloidosis.
Aims
to prospectively evaluate the prognostic role of BP by using standard and 24 hour BP measurements and evaluate the importance of the deregulation of ANS in AL amyloidosis by assessing Baroreceptor reflex sensitivity (BRS).
Methods
Newly diagnosed patients, with biopsy confirmed AL amyloidosis, were prospectively evaluated. All patients underwent standard office BP office BP measurements (three BP measurements taken at a 1-min intervals, at sitting position, averaged to obtain a single systolic and diastolic office BP value), 24h ambulatory BP monitoring and a simultaneously electrocardiographic and non-invasive BP monitoring (Finometer), under standardized conditions for 15 min. Ambulatory BP monitoring was performed on a usual working day. BP recordings were obtained automatically at 15-min intervals throughout the 24h period. BRS was expressed as the alpha-index (a-index), which was estimated by means of power spectral analysis.
Results
we evaluated 68 consecutive patients (median age 65, range 40-84 years, 50% males). Heart was involved in 65%, kidneys in 70% and nervous system in 23%, while 10% were Mayo stage-1, 60% stage-2 and 30% stage-3 and 14% had NTproBNP≥8500 ng/L. Median eGFR was 63 ml/min/1.73 m2. Primary treatment was bortezomib-based (VD, VCD or BMDex) in 80% and MDex in 20%. Median office systolic BP (SBP) was 118 mmHg and median diastolic BP (DBP) was 72 mmHg. SBP was lower in stage 2 vs stage 1 and stage 3 vs either stage 2 or stage 1 patients (p=0.026) but there was no difference in the DBP between groups. The median of mean 24h ambulatory SBP was 112.5 mmHg and for DBP was 69.5 mmHg. Advanced Mayo stage was associated with lower mean 24h SBP (p=0.048). None of the patients with Mayo stage 1, 13% of those with stage-2 and 33% of those with stage-3 had office SBP<100 mmHg. For 24h mean SBP, none with stage 1, 23% with stage 2 and 42% with stage 3 had mean ambulatory SBP<100 mmHg. Lower levels of SBP were associated with inferior survival: either office SBP <100 mmHg (6 months vs not reached) (p<0.001) or mean 24h SBP<90 mmHg (2 months vs not reached) (p<0.001) were associated with poor survival and early death. Further analysis of 24h ambulatory BP recordings indicated higher BP fluctuations among patients with less severe or no heart involvement, while more often patients with Mayo stage 3 had higher nighttime vs daytime SBP values than stage 2 or stage 1 patients. Median a-index was 2.85 (range 0.4-5.85) but it was lower in patients with advanced cardiac involvement and was also lower in patients who had nerve involvement (median 1.6 vs 3.3, p=0.016), reflecting both cardiac and nerve involvement by AL amyloidosis. In addition, low a-index was associated with early death.
Conclusion
Low BP, either measured in a sitting position as in standard office visits or by means of 24h ambulatory measurement, is associated with poor prognosis in patients with AL amyloidosis. Impaired BRS is associated with advanced cardiac and nerve involvement and risk of early death.
Session topic: E-poster
Keyword(s): Amyloidosis
Abstract: E1306
Type: Eposter Presentation
Background
cardiac dysfunction is the major determinant of prognosis in patients with AL amyloidosis. Elevated levels of cardiac biomarkers (troponin and of NTproBNP) identify patients at high risk (stage 3 per Mayo stage) but low blood pressure (BP) is independently associated with poor prognosis especially in patients with Mayo stage-3 disease (Wechalekar et al Blood 2013). Cardiac output and autonomic nervous system (ANS) are major regulators of BP and both are affected in AL amyloidosis.
Aims
to prospectively evaluate the prognostic role of BP by using standard and 24 hour BP measurements and evaluate the importance of the deregulation of ANS in AL amyloidosis by assessing Baroreceptor reflex sensitivity (BRS).
Methods
Newly diagnosed patients, with biopsy confirmed AL amyloidosis, were prospectively evaluated. All patients underwent standard office BP office BP measurements (three BP measurements taken at a 1-min intervals, at sitting position, averaged to obtain a single systolic and diastolic office BP value), 24h ambulatory BP monitoring and a simultaneously electrocardiographic and non-invasive BP monitoring (Finometer), under standardized conditions for 15 min. Ambulatory BP monitoring was performed on a usual working day. BP recordings were obtained automatically at 15-min intervals throughout the 24h period. BRS was expressed as the alpha-index (a-index), which was estimated by means of power spectral analysis.
Results
we evaluated 68 consecutive patients (median age 65, range 40-84 years, 50% males). Heart was involved in 65%, kidneys in 70% and nervous system in 23%, while 10% were Mayo stage-1, 60% stage-2 and 30% stage-3 and 14% had NTproBNP≥8500 ng/L. Median eGFR was 63 ml/min/1.73 m2. Primary treatment was bortezomib-based (VD, VCD or BMDex) in 80% and MDex in 20%. Median office systolic BP (SBP) was 118 mmHg and median diastolic BP (DBP) was 72 mmHg. SBP was lower in stage 2 vs stage 1 and stage 3 vs either stage 2 or stage 1 patients (p=0.026) but there was no difference in the DBP between groups. The median of mean 24h ambulatory SBP was 112.5 mmHg and for DBP was 69.5 mmHg. Advanced Mayo stage was associated with lower mean 24h SBP (p=0.048). None of the patients with Mayo stage 1, 13% of those with stage-2 and 33% of those with stage-3 had office SBP<100 mmHg. For 24h mean SBP, none with stage 1, 23% with stage 2 and 42% with stage 3 had mean ambulatory SBP<100 mmHg. Lower levels of SBP were associated with inferior survival: either office SBP <100 mmHg (6 months vs not reached) (p<0.001) or mean 24h SBP<90 mmHg (2 months vs not reached) (p<0.001) were associated with poor survival and early death. Further analysis of 24h ambulatory BP recordings indicated higher BP fluctuations among patients with less severe or no heart involvement, while more often patients with Mayo stage 3 had higher nighttime vs daytime SBP values than stage 2 or stage 1 patients. Median a-index was 2.85 (range 0.4-5.85) but it was lower in patients with advanced cardiac involvement and was also lower in patients who had nerve involvement (median 1.6 vs 3.3, p=0.016), reflecting both cardiac and nerve involvement by AL amyloidosis. In addition, low a-index was associated with early death.
Conclusion
Low BP, either measured in a sitting position as in standard office visits or by means of 24h ambulatory measurement, is associated with poor prognosis in patients with AL amyloidosis. Impaired BRS is associated with advanced cardiac and nerve involvement and risk of early death.
Session topic: E-poster
Keyword(s): Amyloidosis
Type: Eposter Presentation
Background
cardiac dysfunction is the major determinant of prognosis in patients with AL amyloidosis. Elevated levels of cardiac biomarkers (troponin and of NTproBNP) identify patients at high risk (stage 3 per Mayo stage) but low blood pressure (BP) is independently associated with poor prognosis especially in patients with Mayo stage-3 disease (Wechalekar et al Blood 2013). Cardiac output and autonomic nervous system (ANS) are major regulators of BP and both are affected in AL amyloidosis.
Aims
to prospectively evaluate the prognostic role of BP by using standard and 24 hour BP measurements and evaluate the importance of the deregulation of ANS in AL amyloidosis by assessing Baroreceptor reflex sensitivity (BRS).
Methods
Newly diagnosed patients, with biopsy confirmed AL amyloidosis, were prospectively evaluated. All patients underwent standard office BP office BP measurements (three BP measurements taken at a 1-min intervals, at sitting position, averaged to obtain a single systolic and diastolic office BP value), 24h ambulatory BP monitoring and a simultaneously electrocardiographic and non-invasive BP monitoring (Finometer), under standardized conditions for 15 min. Ambulatory BP monitoring was performed on a usual working day. BP recordings were obtained automatically at 15-min intervals throughout the 24h period. BRS was expressed as the alpha-index (a-index), which was estimated by means of power spectral analysis.
Results
we evaluated 68 consecutive patients (median age 65, range 40-84 years, 50% males). Heart was involved in 65%, kidneys in 70% and nervous system in 23%, while 10% were Mayo stage-1, 60% stage-2 and 30% stage-3 and 14% had NTproBNP≥8500 ng/L. Median eGFR was 63 ml/min/1.73 m2. Primary treatment was bortezomib-based (VD, VCD or BMDex) in 80% and MDex in 20%. Median office systolic BP (SBP) was 118 mmHg and median diastolic BP (DBP) was 72 mmHg. SBP was lower in stage 2 vs stage 1 and stage 3 vs either stage 2 or stage 1 patients (p=0.026) but there was no difference in the DBP between groups. The median of mean 24h ambulatory SBP was 112.5 mmHg and for DBP was 69.5 mmHg. Advanced Mayo stage was associated with lower mean 24h SBP (p=0.048). None of the patients with Mayo stage 1, 13% of those with stage-2 and 33% of those with stage-3 had office SBP<100 mmHg. For 24h mean SBP, none with stage 1, 23% with stage 2 and 42% with stage 3 had mean ambulatory SBP<100 mmHg. Lower levels of SBP were associated with inferior survival: either office SBP <100 mmHg (6 months vs not reached) (p<0.001) or mean 24h SBP<90 mmHg (2 months vs not reached) (p<0.001) were associated with poor survival and early death. Further analysis of 24h ambulatory BP recordings indicated higher BP fluctuations among patients with less severe or no heart involvement, while more often patients with Mayo stage 3 had higher nighttime vs daytime SBP values than stage 2 or stage 1 patients. Median a-index was 2.85 (range 0.4-5.85) but it was lower in patients with advanced cardiac involvement and was also lower in patients who had nerve involvement (median 1.6 vs 3.3, p=0.016), reflecting both cardiac and nerve involvement by AL amyloidosis. In addition, low a-index was associated with early death.
Conclusion
Low BP, either measured in a sitting position as in standard office visits or by means of 24h ambulatory measurement, is associated with poor prognosis in patients with AL amyloidosis. Impaired BRS is associated with advanced cardiac and nerve involvement and risk of early death.
Session topic: E-poster
Keyword(s): Amyloidosis
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