Should We Amplify Cardiac Response Criteria in Patients with Cardiac Light-Chain Amyloidosis Treated with Bortezomib?

Abstracts S169 difference in parameters of RV function (TAPSE: 1.85±0.47 cm vs. 1.89±0.44 cm, P= 0.71; St: 10.4±2.9 cm/s vs. 10.3±3.2 cm/s, P= 0.80; FAC: 29±7% vs. 30±8%, P= 0.58). At 6 months, we found a significant improvement in RV function in SC Group (TAPSE: +0.42±0.64 cm, P= 0.001; St: +1.28±2.4 cm/s; P= 0.04; FAC: +9±5%, P= 0.03), but not in Controls (TAPSE: -0.04±0.44 cm, P= 0.32; St: -0.08±1.2 cm/s; P= 0.44; FAC: -2±3%, P= 0.53). In the SC Group we also found a significant increase in LVEF (+5.1±3.3%, P= 0.01) and decrease in NTproBNP (-678±211 pg/ml, P= 0.02). However, on multivariate analysis, changes in LVEF and NTproBNP did not correlate with RV function improvement (P= 0.32 and 0.22, respectively). Conclusion: In patients with DCM, CD34+ cell therapy appears to be associated with improved right ventricular function. Further studies are needed to investigate whether such approach may also benefit patients with long-term left ventricular mechanical circulatory support. 4( 32) Should We Amplify Cardiac Response Criteria in Patients with Cardiac Light-Chain Amyloidosis Treated with Bortezomib? J. Vázquez , A. Durante, F. Hernández, V. Moñivas Palomero, S. Mingo, I. Sayago, P. García Pavía, L. Alonso-Pulpón, J. Segovia Cubero.  Cardiology, Hospital Puerta de Hierro, Madrid, Spain. Purpose: Heart involvement in systemic light-chain amyloidosis (ALCAM) confers an ominous prognosis. New treatments, including Bortezomib (BOR), achieved better prognosis by increasing the patients with cardiac response (CarR). Traditionally, CarR has been defined by a > 30% decrease in NTproBNP. Recent research suggest that echocardiography (Echo) could provide new cardiac response criteria with additional prognostic value. Our aim was to evaluate the usefulness of Echo CarR criteria. Methods: We analyse 35 ALCAM patients who received Bortezomib in our hospital between 2005-2016. Mean follow-up was 31 months. Proposed CarR criteria were: 1) classic criteria of > 30% decrease in NT-proBNP, 2) ≥ 10% improvement in LVEF by Echo or 3) reduction ≥ 2 mm in septal thickness by Echo. 4 patients who underwent heart transplant and 2 patients with followup < 3 months were excluded. In order to assess the relative value of CarR criteria, we analyzed survival according to CarR subtype: a) absence of CarR, b) isolated analytic CarR (decrease of NTproBNP), c) isolated echocardiographic CaR (improvement in LVEF and/or reduction in septal thickness) and d) presence of both CarR subtypes. Results: 17 patients showed CarR of any type after BOR therapy (60%), showing better survival when compared to patients without CarR. 9 patients (32%) showed isolated NTproBNP reduction, with favourable prognosis. 3 patients had isolated Echo CarR (10.7%), and showed a prognosis similar to patients with classic analytic CarR. Finally, patients with both subtype CarR seem to have the best prognosis (100% survival at the end of follow-up). Conclusion: Echo-based criteria of CarR identified a subgroup without classic analytic CarR and a favourable prognosis similar to patients with a decrease in NTproBNP. The presence of both types of responses seems to identify the subgroup with the best prognosis. If these results are confirmed in larger studies, Echo CaR criteria should be incorporated to CarR global criteria.

4( 33) Beta Blocker Use in Patients with LVADs Is Associated with Lower proBNP and Is Not Associated with Heart Failure Hospitalizations or an Increase in Adverse Events G. Vaidya , B.C. Salgado, J. Pillarella, C.L. Dunbar-Matos, R. Vijayakrishnan, A. Lenneman, M.S. Slaughter, E. Birks, D. Abramov.  Division of Cardiovascular Medicine, University of Louisville, Louisville, KY. Purpose: While Beta Blockers (BB) are recognized as important in management of advanced heart failure, use of BB post left ventricular assist device (LVAD) implantation remains controversial. Concern has been raised about the possible effects of BB on right ventricular function post LVAD implantation. The purpose of this study was to evaluate the safety of BB use post LVAD implantation. Methods: Retrospective review of patients implanted with a continuous flow LVAD between 2012 and 2015 at our center. The use of BB, key patient characteristics, and echocardiographic (echo) variables were collected at 6 months post implant. Mortality and heart failure hospitalizations were followed for 12 months after the 6th month demographic and echo data. Patient characteristics and outcomes in patients on versus off BB were compared. BB use was at the discretion of the advanced heart failure team. Prevalence and percentages in the table represent patients with available and interpretable data for each variable. Results: 98 patients were identified. Mean age was 57 ± 14 years, 81% were men and 61% were ischemic. At 6 months post-implantation, 72 patients (73%) were on BB. Key demographic, laboratory, and echo characteristics were similar between groups (Table 1), however, patients on BB tended to have lower proBNP at 6 and 12 months. Approximately half the patients in both groups had greater than moderate (moderate-severe or severe) RV dysfunction and 20% of patients had greater than moderate RV dilation. On 12 months follow up after the 6th month echo, there was no significant difference in heart failure hospitalization (14% vs 15%) among patients on and off BB and instead a trend towards less deaths in those on BB (6% vs 15%) Conclusion: The use of BB post LVAD implantation appears safe and was associated with a lower proBNP, including in patient population with significant prevalence of RV dilation and dysfunction. The use of BB in LVAD patients deserves further investigation.

Table 1: Key demographic, laboratory, and echocardiographic characteristics between groups

Age Ischemic cardiomyopathy Creatinine Bilirubin proBNP (at 6 months) proBNP (at 12 months) LVEDD RA pressure No/Mild RV dysfunction Moderate RV dysfunction Greater than moderate RV dysfunction No/Mild RV dilation Moderate RV dilation Greater than moderate RV dilation Greater than moderate AI Greater than moderate MR Greater than moderate TR CHF hospitalization Death

On BB (n= 72)

Off BB(n= 26)

P-value

55 ±14 63%

63 ± 11 62%

0.02 0.93

1.4 ± 0.7 0.9 ± 0.4 1915 ± 2860

1.4 ± 0.8 1.1 ± 1.2 4217 ± 5983

0.78 0.25 0.01

2260 ± 4538

5188 ± 10590

0.08

6.5 ±1.4 10 ± 4 14 (26%)

5.7 ± 1.2 11 ± 4 5 (24%)

0.03 0.67 0.68

13 (24%)

7 (33%)

0.68

28 (51%)

9 (43%)

0.68

28 (54%) 14 (27%) 10 (19%)

6 (30%) 10 (50%) 4 (20%)

0.13 0.13 0.13

4 (8%)

2 (10%)

0.75

13 (24%)

5 (26%)

0.85

11 (22%)

5 (26%)

0.67

10 (14%) 4 (6%)

4 (15%) 4 (15%)

0.85 0.12