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Prevalence and prognostic value of monoclonal gammopathy in heart failure patients with preserved ejection fraction: A prospective study

Ana Devesa Arbiol, Celia Rodríguez Olleros, Xhorxhi Kaçi, Elham Askari, Andrea Camblor Blasco, Ana María Pello Lázaro, Sandra Gómez Talavera, Juan Gómez Octavio, Gregoria Lapeña, Felipe Navarro, José Tuñón, Borja Ibáñez, Álvaro Aceña
DOI: 10.5603/CJ.a2020.0059
·
Pubmed: 32329041

open access

Ahead of print
Original articles
Published online: 2020-04-17

Abstract

Background: Heart failure (HF) with preserved ejection fraction (HFpEF) and monoclonal gammopathy of uncertain significance (MGUS) are two entities that share pathophysiological mechanisms. The aim herein, was to assess the prevalence of MGUS in patients with HFpEF and no left ventricular (LV) hypertrophy, as well as its association with a pre-specified clinical endpoint at 12 months.

Methods: The present study prospectively enrolled 69 patients admitted with HF, with ejection fraction ≥ 50%, and LV wall thickness < 12 mm. All patients were screened for MGUS. Clinical events were determined over a 12 month follow-up. The pre-specified composite clinical endpoint was readmission for heart failure or death.

Results: The prevalence of MGUS in this population was 13%. There were no differences in the incidence of the composite clinical endpoint between patients with and without MGUS. Multivariate analysis showed that treatment with angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) was associated with fewer clinical events (HR: 0.153, 95% CI: 0.037–0.622, p = 0.009) and indicated a trend to lower risk of readmission for HF and death. Beta-blockers were associated with lower rates of the composite clinical endpoint (HR: 0.192, 95% CI: 0.05–0.736, p = 0.016), readmission for HF (HR: 0.272, 95% CI: 0.087–0.851, p = 0.025) and indicated a trend to lower mortality. Moreover, potassium serum levels > 5 mEq/L were associated with higher rates of the composite endpoint (HR: 6.074, 95% CI: 1.6–22.65,p = 0.007).

Conclusions: The prevalence of MGUS in patients with HFpEF without hypertrophy was 3-fold that of the general population. There was no significant correlation between clinical outcomes and the presence of MGUS. Beta-blockers and ACEIs/ARBs reduced the composite of mortality and readmissions for HF in HFpEF patients. Hyperpotassemia was related to worse prognosis.

Abstract

Background: Heart failure (HF) with preserved ejection fraction (HFpEF) and monoclonal gammopathy of uncertain significance (MGUS) are two entities that share pathophysiological mechanisms. The aim herein, was to assess the prevalence of MGUS in patients with HFpEF and no left ventricular (LV) hypertrophy, as well as its association with a pre-specified clinical endpoint at 12 months.

Methods: The present study prospectively enrolled 69 patients admitted with HF, with ejection fraction ≥ 50%, and LV wall thickness < 12 mm. All patients were screened for MGUS. Clinical events were determined over a 12 month follow-up. The pre-specified composite clinical endpoint was readmission for heart failure or death.

Results: The prevalence of MGUS in this population was 13%. There were no differences in the incidence of the composite clinical endpoint between patients with and without MGUS. Multivariate analysis showed that treatment with angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) was associated with fewer clinical events (HR: 0.153, 95% CI: 0.037–0.622, p = 0.009) and indicated a trend to lower risk of readmission for HF and death. Beta-blockers were associated with lower rates of the composite clinical endpoint (HR: 0.192, 95% CI: 0.05–0.736, p = 0.016), readmission for HF (HR: 0.272, 95% CI: 0.087–0.851, p = 0.025) and indicated a trend to lower mortality. Moreover, potassium serum levels > 5 mEq/L were associated with higher rates of the composite endpoint (HR: 6.074, 95% CI: 1.6–22.65,p = 0.007).

Conclusions: The prevalence of MGUS in patients with HFpEF without hypertrophy was 3-fold that of the general population. There was no significant correlation between clinical outcomes and the presence of MGUS. Beta-blockers and ACEIs/ARBs reduced the composite of mortality and readmissions for HF in HFpEF patients. Hyperpotassemia was related to worse prognosis.

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Keywords

monoclonal gammopathy, heart failure, inflammation, ACEI, ARB

About this article
Title

Prevalence and prognostic value of monoclonal gammopathy in heart failure patients with preserved ejection fraction: A prospective study

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-04-17

DOI

10.5603/CJ.a2020.0059

Pubmed

32329041

Keywords

monoclonal gammopathy
heart failure
inflammation
ACEI
ARB

Authors

Ana Devesa Arbiol
Celia Rodríguez Olleros
Xhorxhi Kaçi
Elham Askari
Andrea Camblor Blasco
Ana María Pello Lázaro
Sandra Gómez Talavera
Juan Gómez Octavio
Gregoria Lapeña
Felipe Navarro
José Tuñón
Borja Ibáñez
Álvaro Aceña

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