Clinical value of post-treatment assessment of peripheral vascular and hemodynamic markers in AL amyloidosis
I Petropoulos, R Patras, G Mavraganis, D Delialis, F Theodorakakou, C Zotika, L Angelidakis, C Konstantaki, A Alifragki, A Dimoula, E Repasos, G Georgiopoulos, M A Dimopoulos, E Kastritis, K StamatelopoulosAbstract
Background/Introduction
Peripheral vascular involvement at diagnosis of AL amyloidosis is prognostic of increased mortality. However, the clinical utility of post-treatment vascular assessment remains unknown.
Purpose
To evaluate longitudinal changes and prognostic value of peripheral vascular and hemodynamic markers following treatment in AL amyloidosis patients.
Methods
We prospectively assessed 140 AL amyloidosis patients at baseline, 3 months, and 6-12 months post-treatment in our high-volume center of excellence in amyloidosis. Flow-mediated dilation (FMD), pulse wave velocity (PWV), augmentation index (AI@75) and central/peripheral blood pressures were measured. Patients were stratified by hematologic response (complete/very good response vs. partial/no response). Multivariable Cox regression evaluated associations between markers of vascular involvement with all-cause mortality with a maximum follow-up of 72 months, adjusting for age, Mayo stage, cardiac involvement, nerve involvement and baseline hypotension.
Results
At 3 months post-treatment, patients with complete hematologic response showed early FMD decrease from 3.95 (1.82-6.28) to 3.3 (1.38 5.85)(p=0.048) while all patients presented modest blood pressure reductions (p<0.05) regardeless of hematologic response. After 6 months, in all survivors, vascular markers converged regardeless of hematologic response depth (p=0.648-0.673). By multivariable analysis, at 6 months post treatment lower central SBP (HR 0.89 CI: 0.84, 0.95, p<0.001), pulse pressure (HR 0.94 CI: 0.91,0.98, p<0.003), PWV (HR 0.66 CI: 0.48, 0.92, p=0.015) and AI@75 (HR 0.91 CI: 0.86, 0.96, p= <0.001) and higher FMD (HR 1.18 CI: 1.01, 1.40, p=0.048) predicted worse outcomes. Moreover, elevated FMD (>6) at 12 months independently predicted increased mortality risk (HR 4.78, 95% CI 1.11, 20.49; p=0.036).
Conclusions
In survivors with AL-amyloidosis, after 6 months of treatment, vascular and hemodynamic markers tetain prognostic value independent of established predictors for the disease. These results suggest that longitudinal vascular assessment in AL-amyloidosis may be useful in post-treatment risk stratification of the disease.FMD_PWV_figurefigure2_logarnk