The importance of cardiac biomarker assay for the stratification and monitoring of AL amyloidosis patients – single center experience

Czech version

Authors: T. Pika ¹; P. Lochman ²; J. Vymětal ¹; R. Metelka ¹; P. Flodr ³; J. Minařík ¹; P. Látalová ³; J. Zapletalová ⁴; J. Bačovský ¹; V. Ščudla ¹
Authors‘ workplace: III. interní klinika – nefrologická, revmatologická, endokrinologická Lékařské fakulty UP a FN Olomouc, přednosta prof. MU Dr. Josef Zadražil, CSc. 2 Oddělení klinické biochemie FN Olomouc, přednosta doc. RNDr. Tomáš Adam, Ph. D. 3 Ústav klinické a mole ¹
Published in: Vnitř Lék 2013; 59(9): 776-781
Category: Original Contributions

Overview

Introduction:
Cardiac involvement is a dominant prognostic factor in AL amyloidosis patients. A detailed assessment of the presence and degree of cardiac involvement utilizes an array of non‑invasive investigation methods, particularly echocardiography and MRI; laboratory parameters include troponins and natriuretic peptides. Cardiac involvement detection aside, cardiac biomarkers are used as a relatively strong stratification and prognostic factor.

Objective:
The presentation of cardiac biomarkers assay applications in AL amyloidosis patients at an individual treatment center.

Patients and methods:
The monitored patient set consisted of 22 patients with histologically confirmed AL amyloidosis, of whom 18 met the criteria for cardiac involvement. Levels of cardiac biomarkers troponin T (TnT) and N‑terminal pro‑brain natriuretic peptide (NT‑ ProBNP) were determined in all patients. Risk stratification of the patients utilized the Mayo staging system which is based on both biomarkers’ assays; Log Rank Test was applied to survival evaluation.

Results:
Median survival of patients with cardiac involvement stigmata was 10 months vs 60 months survival of patients without signs of cardiac involvement (p = 0.133). Of the 4 patients without cardiac involvement, 1 has shown positive levels of TnT and 2 positive levels of NT‑ ProBNP. All cardiac involvement patients exhibited abnormal levels of NT‑ ProBNP (median 4,752 ng/ l; 415.7– 35,000) as well as positive levels of TnT (median 0.0815 μg/ l; 0.02– 0.986). The application of the Mayo stratification system to the set had determined 2 patients at stage I, 5 patients at stage II and 15 patients at stage III. The median survival of the Mayo I + II group vs the Mayo III group was 60 vs 6 months (p = 0.015), revealing extremely limited survival of stage III patients. Assessment of TnT and NT‑ ProBNP levels relative to treatment response shows that the degree of decrease in both markers depends on maximum treatment response – respectively the attainment of a complete hematological remission.

Conclusion:
The results, although obtained from a limited set of patients, confirm a definitive benefit of the application of cardiac biomarkers assay in the diagnostic and therapeutic algorithm of AL amyloidosis patients. The Mayo stratification system utilizing the cardiac indicator values represents a robust tool for risk stratification of AL amyloidosis patients.

Key words:
AL amyloidosis – cardiac involvement – troponin – natriuretic peptides

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