CC BY 4.0Ihne-Schubert, Sandra MichaelaSandra MichaelaIhne-SchubertGoetze, OliverOliverGoetzeGerstendörfer, FelixFelixGerstendörferSahiti, FloranFloranSahitiSchade, InaInaSchadePapagianni, AikateriniAikateriniPapagianniMorbach, CarolineCarolineMorbachFrantz, StefanStefanFrantzEinsele, HermannHermannEinseleKnop, StefanStefanKnopSommer, ClaudiaClaudiaSommerMüllhaupt, BeatBeatMüllhauptStörk, StefanStefanStörkSchubert, TorbenTorbenSchubertGeier, AndreasAndreasGeier2024-04-082024-04-082024https://publica.fraunhofer.de/handle/publica/465846https://doi.org/10.24406/publica-290310.3390/jcm1305144010.24406/publica-2903Background: Congestion is associated with poor prognosis in cardiac amyloidosis (CA). The cardio-hepatic interaction and the prognostic impact of secondary liver affection by cardiac congestion in CA are poorly understood and require further characterisation. Methods: Participants of the amyloidosis cohort study AmyKoS at the Interdisciplinary Amyloidosis Centre of Northern Bavaria with proven transthyretin (ATTR-CA) and light chain CA (AL-CA) underwent serial work-up including laboratory tests, echocardiography, and in-depth hepatic assessment by vibration-controlled transient elastography (VCTE) and 13C-methacetin breath test. Results: In total, 74 patients with AL-CA (n = 17), ATTR-CA (n = 26) and the controls (n = 31) were analysed. ATTR-CA patients showed decreased microsomal liver function expressed by maximal percentage of dose rate (PDRpeak) related to hepatic congestion. Reduced PDRpeak in AL-CA could result from altered pharmacokinetics due to changed hepatic blood flow. Liver stiffness as a combined surrogate of chronic liver damage and congestion was identified as a predictor of all-cause mortality. Statistical modelling of the cardio-hepatic interaction revealed septum thickness, NT-proBNP and PDRpeak as predictors of liver stiffness in both CA subtypes; dilatation of liver veins and the fibrosis score FIB-4 were only significant for ATTR-CA. Conclusions: Non-invasive methods allow us to characterise CA-associated hepatic pathophysiology. Liver stiffness might be promising for risk stratification in CA.enCardiac amyloidosis13C-methacetin breath test (MBT)Liver stiffnessVibration-controlled transient elastography (VTCE)PDRCongestionjournal article