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Bodez D, Guellich A, Kharoubi M, Covali-Noroc A, Tissot CM, Guendouz S, Hittinger L, Dubois-Randé JL, Lefaucheur JP, Planté-Bordeneuve V, Adnot S, Boyer L, Damy T. Prevalence, Severity, and Prognostic Value of Sleep Apnea Syndromes in Cardiac Amyloidosis. Sleep 2016; 39:1333-41. [PMID: 27091529 DOI: 10.5665/sleep.5958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/24/2016] [Indexed: 12/20/2022] Open
Abstract
STUDY OBJECTIVES To assess prevalence, severity, and prognostic value of sleep-disordered breathing (SDB), in the three main cardiac amyloidosis (CA) types, i.e., light-chain (AL), transthyretin-related familial (m-TTR), or senile (WT-TTR). METHODS Patients consecutively referred for CA diagnosis work-up underwent cardiac assessment and nocturnal polygraphy. SDB was defined as apnea-hypopnea index (AHI) ≥ 5/h. Multivariate analysis was used to identify predictors of a major adverse cardiac event (MACE) defined as death, heart transplantation and acute heart failure. RESULTS Seventy CA patients were included (31 AL, 22 m-TTR, 17 WT-TTR). The mean ± standard deviation age and left ventricular ejection fraction were 71 ± 12 years and 49% ± 13% and median (interquartile range) N terminal pro brain natriuretic peptide (NT-proBNP) was 3,932 (1,607; 7,028) pg/mL. The prevalence of SDB was 90% without difference between amyloidosis types. SDB was central in 27% and obstructive in 73%. AL had less frequent severe SDB compared to m-TTR and WT-TTR (P = 0.015) but longer time with peripheral capillary oxygen saturation (SpO2) < 90% (P = 0.037). After a median follow-up of 7.5 (2.8; 14.9) months, 49% patients experienced MACE. Time with nocturnal SpO2 < 90% was the only independent predictor of MACE. The best-identified threshold was 30 min. Values > 30 min were associated with bad prognosis (Log-rank χ(2): 8.01, P value = 0.005). Using binomial logistic regression, determinants of time with nocturnal SpO2 < 90% were New York Heart Association class (P = 0.011), and log-NT-proBNP (P = 0.04) but not AHI. CONCLUSIONS In CA population, prevalence of SDB is high (90%) and dominated by the obstructive pattern. Bad prognosis in this population was driven by nocturnal desaturation, reflecting heart failure severity and respiratory involvement.
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Affiliation(s)
- Diane Bodez
- Cardiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Mondor Amyloidosis Network, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,INSERM U955, UPEC, IMRB, GRC Amyloid Research Institute, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Aziz Guellich
- Cardiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Mondor Amyloidosis Network, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,INSERM U955, UPEC, IMRB, GRC Amyloid Research Institute, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Mounira Kharoubi
- Cardiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Mondor Amyloidosis Network, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,INSERM U955, UPEC, IMRB, GRC Amyloid Research Institute, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Clinical Investigation Centre, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Ala Covali-Noroc
- Physiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Claire-Marie Tissot
- Cardiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Mondor Amyloidosis Network, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,INSERM U955, UPEC, IMRB, GRC Amyloid Research Institute, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Soulef Guendouz
- Cardiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Mondor Amyloidosis Network, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,INSERM U955, UPEC, IMRB, GRC Amyloid Research Institute, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Luc Hittinger
- Cardiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Mondor Amyloidosis Network, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Jean-Luc Dubois-Randé
- Cardiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Mondor Amyloidosis Network, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Jean-Pascal Lefaucheur
- INSERM U955, UPEC, IMRB, GRC Amyloid Research Institute, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Physiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Violaine Planté-Bordeneuve
- Mondor Amyloidosis Network, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,INSERM U955, UPEC, IMRB, GRC Amyloid Research Institute, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Neurology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Serge Adnot
- DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Physiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Laurent Boyer
- DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Physiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France
| | - Thibaud Damy
- Cardiology Department, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Mondor Amyloidosis Network, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,INSERM U955, UPEC, IMRB, GRC Amyloid Research Institute, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,DHU ATVB, AP-HP Henri Mondor Teaching Hospital, Créteil, France.,Clinical Investigation Centre, AP-HP Henri Mondor Teaching Hospital, Créteil, France
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Abstract
BACKGROUND Hereditary gelsolin amyloidosis (AGel amyloidosis) is an age-associated systemic disease with global distribution, caused by a G654A or G654T gelsolin gene mutation. Cutis laxa is a principal clinical manifestation of this disease. However, only few data on the dermatological involvement are available, and the pathogenesis of this amyloidosis-associated form of cutis laxa has remained unknown. OBJECTIVES To elucidate the pathomechanism of this less well-known genodermatosis. METHODS We performed systematic clinical, histological, immunohistochemical and ultrastructural skin biopsy studies in 12 patients with a G654A gelsolin gene mutation. For comparison, skin specimens from 10 control subjects were analysed. RESULTS All patients had clinically characteristic cutis laxa, and frequently other signs of symptomatic skin disease such as increased fragility and risk for intracutaneous bleeding. All patients showed cutaneous deposition of gelsolin amyloid (AGel), mainly attached to basement membranes or basal laminae of various cutaneous structures, dermal nerves and blood vessel walls, and elastic fibres, particularly in the lower reticular dermis. AGel often encircled the elastic fibres, and colocalized with amyloid P component (AP), an elastic fibre microfibrillar sheath-associated protein. Fragmentation and loss of elastic fibres, epidermal atrophy, and reduction of dermal appendages were also common. Antibodies to wild-type gelsolin bound to S-100-positive epidermal dendritic cells, a previously unrecognized immunoreaction. Patients had fewer gelsolin-positive dendritic cells than controls. CONCLUSIONS Widespread skin involvement with AGel deposition and elastic fibre involvement are essential pathological features in AGel amyloidosis, and contribute to the characteristic cutis laxa, dramatic in old age. Codistribution of AGel and AP, with demonstrated specific binding affinity for amyloid fibrils, suggests that elastic fibre-associated AP acts as a matrix for cutaneous amyloid deposition in AGel amyloidosis.
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Affiliation(s)
- S Kiuru-Enari
- Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290 Helsinki, Finland.
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