Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation
Top Cited Papers
Open Access
- 8 April 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 41 (29), 2759-2767
- https://doi.org/10.1093/eurheartj/ehaa170
Abstract
Aims: Cardiac amyloidosis is common in elderly patients with aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI). We hypothesized that patients with dual aortic stenosis and cardiac amyloid pathology (AS-amyloid) would have different baseline characteristics, periprocedural and mortality outcomes. Methods and results: Patients aged ≥75 with severe AS referred for TAVI at two sites underwent blinded bone scintigraphy prior to intervention (Perugini Grade 0 negative, 1–3 increasingly positive). Baseline assessment included echocardiography, electrocardiogram (ECG), blood tests, 6-min walk test, and health questionnaire, with periprocedural complications and mortality follow-up. Two hundred patients were recruited (aged 85 ± 5 years, 50% male). AS-amyloid was found in 26 (13%): 8 Grade 1, 18 Grade 2. AS-amyloid patients were older (88 ± 5 vs. 85 ± 5 years, P = 0.001), with reduced quality of life (EQ-5D-5L 50 vs. 65, P = 0.04). Left ventricular wall thickness was higher (14 mm vs. 13 mm, P = 0.02), ECG voltages lower (Sokolow–Lyon 1.9 ± 0.7 vs. 2.5 ± 0.9 mV, P = 0.03) with lower voltage/mass ratio (0.017 vs. 0.025 mV/g/m2, P = 0.03). High-sensitivity troponin T and N-terminal pro-brain natriuretic peptide were higher (41 vs. 21 ng/L, P < 0.001; 3702 vs. 1254 ng/L, P = 0.001). Gender, comorbidities, 6-min walk distance, AS severity, prevalence of disproportionate hypertrophy, and post-TAVI complication rates (38% vs. 35%, P = 0.82) were the same. At a median follow-up of 19 (10–27) months, there was no mortality difference (P = 0.71). Transcatheter aortic valve implantation significantly improved outcome in the overall population (P < 0.001) and in those with AS-amyloid (P = 0.03). Conclusions: AS-amyloid is common and differs from lone AS. Transcatheter aortic valve implantation significantly improved outcome in AS-amyloid, while periprocedural complications and mortality were similar to lone AS, suggesting that TAVI should not be denied to patients with AS-amyloid.Keywords
Funding Information
- British Heart Foundation Clinical Research Training Fellowship (FS/16/31/32185)
This publication has 35 references indexed in Scilit:
- Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo SurgeryThe New England Journal of Medicine, 2010
- Senile systemic amyloidosis affects 25% of the very aged and associates with genetic variation inalpha2‐macroglobulinandtau: A population‐based autopsy studyAnnals of Medicine, 2008
- ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart DiseaseCirculation, 2006
- Noninvasive Etiologic Diagnosis of Cardiac Amyloidosis Using 99mTc-3,3-Diphosphono-1,2-Propanodicarboxylic Acid ScintigraphyJournal of the American College of Cardiology, 2005
- Prevalence of aortic valve abnormalities in the elderly: An echocardiographic study of a random population sampleJournal of the American College of Cardiology, 1993
- Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findingsThe American Journal of Cardiology, 1986
- The effect of aortic valve replacement on survival.Circulation, 1982
- Amyloid cardiomyopathy: Characterization by a distinctive voltage/mass relationThe American Journal of Cardiology, 1982
- Aortic StenosisCirculation, 1968
- The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leadsAmerican Heart Journal, 1949