Universität zu Köln

Nies, Richard J. ORCID: 0000-0002-1336-6031, Ney, Svenja, Nies, Jasper F., Seuthe, Katharina ORCID: 0000-0002-6346-7500, Klösges, Lukas, Brüwer, Monique ORCID: 0000-0002-0152-3407, Nienaber, Stephan ORCID: 0000-0001-5779-7549, Macherey-Meyer, Sascha ORCID: 0000-0002-7080-6611, Schäfer, Matthieu ORCID: 0000-0003-1875-1163 and Pfister, Roman ORCID: 0000-0002-4358-5008 (2025). Outpatient diuretic intensification: a simple prognostic marker in cardiac transthyretin amyloidosis. Clinical Research in Cardiology. pp. 1-11. Springer Nature. ISSN 1861-0684

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Abstract

Background: Currently, simple clinical parameters indicating disease progression are lacking in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). This study aimed to evaluate the prognostic value of outpatient diuretic intensification (ODI) in ATTR-CM patients. Methods: This retrospective study examined ATTR-CM patients at a tertiary care center between August 1, 2020, and June 30, 2023. ODI was defined as any loop diuretic increase within 6 months after baseline visit, and its impact on all-cause mortality and hospitalization for heart failure (HF) was analyzed. Results: Altogether, 182 patients were included (median age 80 [76; 84] years; 88% male), and 25% experienced ODI (median increase 10 [10; 40] mg furosemide equivalent). Independent predictors of ODI were higher baseline New York Heart Association (NYHA) class and polyneuropathy. Both any ODI and the magnitude of furosemide equivalent increase were significantly associated with mortality and HF hospitalization during a median follow-up of 17 months. After adjusting for baseline NYHA class and National Amyloidosis Centre stage, significantly increased risk of all-cause mortality (hazard ratio [HR] 2.38, 95% confidence interval [CI] 1.03–5.53; p = 0.043) and HF hospitalization (HR 3.27, 95% CI 1.41–7.60; p = 0.006) persisted in patients with ODI. Its prognostic value was similar in strata of age, ATTR subtype, previous cardiac decompensation, biomarkers, left ventricular ejection fraction, six-minute walk distance, and tafamidis treatment. Conclusion: ODI occurred in one in four ATTR-CM patients within 6 months and was associated with more severe baseline amyloid organ manifestations. ODI and the magnitude of diuretic dose increase provide easily assessable clinical markers of disease progression in patient monitoring. Graphical abstract: A total of 182 patients diagnosed with transthyretin amyloidosis cardiomyopathy (ATTR-CM) were analyzed for an increase in loop diuretic dosage within the first 6 months after the baseline visit. Twenty-five percent of the cohort experienced outpatient diuretic intensification (ODI), with independent predictors being dyspnea in higher New York Heart Association (NYHA) class and polyneuropathy (PNP). ODI was significantly associated with all-cause mortality, and its prognostic value remained consistent across various risk factors

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Nies, Richard J. UNSPECIFIED https://orcid.org/0000-0002-1336-6031 UNSPECIFIED Ney, Svenja UNSPECIFIED UNSPECIFIED UNSPECIFIED Nies, Jasper F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Seuthe, Katharina UNSPECIFIED https://orcid.org/0000-0002-6346-7500 UNSPECIFIED Klösges, Lukas UNSPECIFIED UNSPECIFIED UNSPECIFIED Brüwer, Monique UNSPECIFIED https://orcid.org/0000-0002-0152-3407 UNSPECIFIED Nienaber, Stephan UNSPECIFIED https://orcid.org/0000-0001-5779-7549 UNSPECIFIED Macherey-Meyer, Sascha UNSPECIFIED https://orcid.org/0000-0002-7080-6611 UNSPECIFIED Schäfer, Matthieu UNSPECIFIED https://orcid.org/0000-0003-1875-1163 UNSPECIFIED Pfister, Roman UNSPECIFIED https://orcid.org/0000-0002-4358-5008 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-797751
Identification Number:	10.1007/s00392-025-02617-4
Journal or Publication Title:	Clinical Research in Cardiology
Page Range:	pp. 1-11
Date:	4 March 2025
Publisher:	Springer Nature
ISSN:	1861-0684
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Innere Medizin > Klinik II für Innere Medizin - Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin Faculty of Medicine > Innere Medizin > Klinik III für Innere Medizin - Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin
Subjects:	Medical sciences Medicine
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/79775