Abstract 16781: Ventriculo-Arterial Coupling is Associated with Death and Need for Ventricular Assist Device or Heart Transplant in Patients with Transthyretin Cardiac Amyloidosis

Background: Transthyretin (TTR) cardiac amyloidosis (CA) results from TTR protein deposition in the extracellular space of the heart altering cardiac chamber mechanics and efficiency. Ventriculo-arterial coupling (VAC) is calculated from 2D echo derived measurements and reflects cardiac function and efficiency. We aimed to identify whether VAC assessment at diagnosis improves current risk stratification models as a prognostic tool. Methods: The Amyloid Heart Disease registry at our institution was used to identify 365 TTR-CA patients. Primary outcome was mortality and advanced heart failure therapy (ventricular assist device (VAD) or heart transplant). Results: At a median follow up of 1.9 years, VAD, transplant or death occurred in 163 (44.7%) patients. On adjusted multivariable Cox survival analysis, the Gillmore Stage which incorporates eGFR and NTproBNP (HR=2.5, 95% CI 1.96-3.18), CAD (HR=1.50 95% CI 1.02-2.20), therapy with Tafamidis (HR=0.31, 95% CI 0.19-0.51), and VAC greater than median (>1.01) (HR=2.28 95% CI 1.57-3.29, p<0.001) were independently associated with outcome (all p<0.05) (Figure). Conclusion: The easily measurable and widely available echo parameter VAC provides incremental independent value in patients with TTR-CA.