title: The combination of high-sensitivity cardiac troponin T (hs-cTnT) at presentation and changes in N-terminal natriuretic peptide type B (NT-proBNP) after chemotherapy best predicts survival in AL amyloidosis.
abstract: In light-chain (AL) amyloidosis, prognosis is dictated by cardiac dysfunction. N-terminal natriuretic peptide type B (NT-proBNP) and cardiac troponins (cTn) are used to assess the severity of cardiac damage. We evaluated the prognostic relevance of a high-sensitivity (hs) cTnT assay, NT-proBNP, and cardiac troponin I in 171 consecutive patients with AL amyloidosis at presentation and 6 months after treatment. Response and progression of NT-proBNP were defined as more than 30% and more than 300 ng/L changes. All 3 markers predicted survival, but the best multivariable model included hs-cTnT. The hs-cTnT prognostic cutoff was 77 ng/L (median survival 10.6 months for patients with hs-cTnT above the cutoff). After treatment, response and progression of NT-proBNP and a more than 75% increase of hs-cTnT were independent prognostic determinant. In AL amyloidosis, hs-cTnT is the best baseline prognostic marker. Therapy should be aimed at preventing progression of cardiac biomarkers, whereas NT-proBNP response confers an additional survival benefit.
authors.affiliation: Amyloidosis Research and Treatment Center and Department of Biochemistry, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo and University of Pavia, Viale Golgi 19, Pavia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palladini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Barassi
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Rosana
authors.initials: R
authors.lastname: Pacciolla
authors.forename: Paolo
authors.initials: P
authors.lastname: Milani
authors.forename: Gabriele
authors.initials: G
authors.lastname: Sarais
authors.forename: Stefano
authors.initials: S
authors.lastname: Perlini
authors.forename: Riccardo
authors.initials: R
authors.lastname: Albertini
authors.forename: Paola
authors.initials: P
authors.lastname: Russo
authors.forename: Andrea
authors.initials: A
authors.lastname: Foli
authors.forename: Letizia Zenone
authors.initials: LZ
authors.lastname: Bragotti
authors.forename: Laura
authors.initials: L
authors.lastname: Obici
authors.forename: Remigio
authors.initials: R
authors.lastname: Moratti
authors.forename: Gian Vico
authors.initials: GV
authors.lastname: Melzi d'Eril
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Merlini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011379:Prognosis; D016019:Survival Analysis; D019210:Troponin I; D020107:Troponin T
chemical_list: D010446:Peptide Fragments; D019210:Troponin I; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain