Kidney Week

Abstract: FR-PO355

Association of an ATTR Cardiomyopathy Risk Score with Cardiac and Kidney Outcomes among Patients with CKD: Insights from CRIC

Session Information

• Hypertension, CVD, and the Kidneys: Epidemiology
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Vale, Catarina, Universidade do Porto Faculdade de Medicina, Porto, Portugal

Catarina Vale, MD

• Vaduganathan, Muthiah, Brigham and Women's Hospital, Boston, Massachusetts, United States

Muthiah Vaduganathan, MD, MPH

• Neuen, Brendon Lange, University of New South Wales, Sydney, New South Wales, Australia

Brendon Lange Neuen, MBBS, MS, PhD, FASN

• Neves, João Sérgio, Universidade do Porto Faculdade de Medicina, Porto, Portugal

João Sérgio Neves, MD

• McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Finnian R. McCausland, MBChB, MS, FASN

Background

Transthyretin amyloid cardiomyopathy (ATTR-CM) is thought to be an underdiagnosed cause of heart failure, especially in HF with preserved ejection fraction (HFpEF). A clinical risk-score to predict ATTR-CM has been validated in HFpEF, but its utility among patients with CKD is unclear.

Methods

We applied a 6-variable risk score (age, sex, hypertension, ejection fraction, relative wall thickness, posterior wall thickness; range -1 to +10) to participants of CRIC with available 1-year echocardiographic data (n=2,718) and calculated the prevalence of a high-risk score (≥6 points). Using Cox regression models, landmarked at 1-year, we explored the adjusted association of a high vs. low-risk score with atrial fibrillation (AF), HF, stroke, myocardial infarction (MI), a kidney composite (kidney failure, ≥50% decline in eGFR, eGFR≤15 mL/min/1.73m²), and all-cause death.

Results

The median score was 4 [2, 5]; 539 (20%) had a high-risk score for ATTR-CM, which was associated with a higher adjusted risk of AF (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.48, 2.35), HF (HR 1.63, 95%CI 1.27, 2.08), MI (HR 1.82, 95%CI 1.33, 2.49) and all-cause mortality (HR 1.60, 95%CI 1.37, 1.87). There was a trend towards a higher risk of stroke with high (vs low) risk score (HR 1.47, 95%CI 0.94, 2.29) but no association with kidney composite (HR 1.01, 95%CI 0.82, 1.23). Using a restricted cubic spline, a monotonic association of higher risk score with death was evident (Figure 1).

Conclusion

1 in 5 individuals in CRIC appear to have a high predicted risk for ATTR-CM. A high-risk score was prognostic for adverse cardiac outcomes and death, but not for a kidney composite outcome. Future studies to examine the true prevalence and to determine the optimal screening pathways for ATTR-CM among patients with CKD are warranted.

Funding

• NIDDK Support