Prognostic value of nutritional and functional status in patients with ATTR-CM: insights from a tertiary referral center
M Vicente Soares, R Carvalho, R Gomes, M Matias, R Montalvao, D Correia, R Amador, T Laranjeira, C Aguiar, S Maltes, B RochaAbstract
Background
Nutritional and performance status assessed by serum albumin and Clinical Frailty Scale (CFS) are well recognized prognostic markers in patients with Heart Failure (HF). Their added value in transthyretin cardiac amyloidosis (ATTR-CM) relative to other wel-established markers remains to be further elucidated.
Aim
To evaluate the prognostic impact of serum albumin and frailty in ATTR-CM.
Methods
All consecutive patients diagnosed with ATTR-CM followed in our center from 2019-2025 were included. As per site protocol, serum albumin and CFS are systematicaly measured at the time of diagnosis, and made available in the electronic chart. The primary endpoint was a composite of all-cause death or first hospitalization for HF. Optimal cutoff values were determined by ROC curve analysis. Kaplan–Meier curves were generated to estimate event-free survival. Univariate and multivariable logistic regression model was then performed, adjusting for clinically relevant variables.
Results
A total of 279 patients were included (82% male; mean age: 83 ± 7 years; 62% on tafamidis; median serum albumin 3.8 [3.5–4.0] g/dL; median CFS 3 [2-4]). ROC curve analysis identified albumin <3.7 g/dL and CFS >3 as the optimal cutoffs (sensitivity 49% and 68%, and specificity 54% and 94%, respectively). Patients with serum albumin <3.7g/dL had significantly worse NYHA ( I-IV: 32 vs. 15%; p=0.004) and higher NT-proBNP (3359 vs. 2140 pg/mL; p=0.004). Likewise, those with a CFS >3 were more likely to have worse NYHA ( I-IV: 38 vs. 17%; p=0.001) and higher NT-proBNP (5718 vs. 2140 pg/mL; p=0.002), and presented with a higher prevalence of atrial fibri lation (85 vs. 63%; p=0.003), lower serum albumin (3.6 vs. 3,8 g/dL; p=0.021), and more often with persistent peripheral congestion (59 vs. 39%; p=0.01) and combined diuretic therapy with mineralocorticoid receptor antagonists (52 vs. 35%; p=0.023). In multivariable logistic regression (adjusted for age, left ventricular ejection fraction, NT-proBNP, NYHA, and tafamidis therapy), both albumin (HR 0.22; 95% CI 0.09–0.54; p=0.001) and CSF (HR 1.43; 95% CI 1.03–1.98; p=0.032) were independently associated with the primary outcome. Moreover, both markers predicted adverse events consistently across age groups, disease stages, and tafamidis treatment status (central figure).
Conclusion
We found that serum albumin and CFS were independently associated with a higher incidence of all-cause mortality or HF hospitalization in ATTR-CM. These easily obtainable clinical measures underscore the importance of incorporating nutritional and functional status assessment as part of the routine risk stratification strategy, adding value beyond traditional cardiovascular parameters.For image description, please refer to the figure legend and surrounding text.