ArticleESC heart failure2026
Prognostic value of heart failure hospitalization in transthyretin cardiac amyloidosis: an international cohort study.
Article in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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18 authors.
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Abstract
introductionData on the impact of a heart failure hospitalization (HFH) on outcome in patients with transthyretin cardiac amyloidosis (TTR-CA) are scarce, although it remains a frequent adverse event. To assess the characteristics of patients with HFH in a real-world TTR-CA population, the occurrence of HFH, and the prognosis thereafter.
methodsData were collected from a multicentre TTR-CA registry and patients were dichotomized according to the occurrence of at least one HFH. Landmark analysis at the 1-year follow-up and Cox regression analysis with HFH as a time-dependent covariate were performed to assess the impact of HFH on all-cause mortality.
resultsOverall, 654 patients were included [median age 78 (64, 83) years, 70.5% male, 70.6% wild type]. During a median follow-up of 24 (11-45) months, 141 (22%) patients experienced at least one HFH and 170 (26%) patients died. Patients with a HFH were older (82 vs 76 years, P < .001), had more wild-type TTR-CA [126 (89.4%) vs 336 (65.5%), P < .001], were more symptomatic [New York Heart Association Class II-IV 119 (86.9%) vs 279 (62%), P < .001], had higher National Amyloidosis Centre (NAC) disease stage, were less treated with disease-modifying therapy [45 (31.9%) vs 247 (47.4%), P = .001], had more co-morbidities and showed signs of more advanced disease by echocardiography. At the 1-year time point, patients with HFH had significant worse overall survival (log-rank χ² 37.673, P < .001). At the univariable (HR 7.71, 95%CI 5.50, 10.82; P < .001) and multivariable analyses, HFH was associated with all-cause mortality and showed incremental value on top of clinical variables, biomarkers [estimated glomerular filtration rate in Model 1 (χ² 97.3; P < .001) and NAC disease stage in Model 2 (χ² 78.8; P < .001)] and echocardiographic parameters (left ventricular mass index + stroke volume index + significant valvular lesion in Model 3 (χ² 60.3; P < .001) and including E/e' in Model 4 (χ² 43.4; P < .001)).
conclusionHFH is independently associated with all-cause mortality in patients with TTR-CA and has incremental value on top of established risk models.
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