Amyloid Transthyretin Cardiomyopathy in Elderly Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

• Published in: Journal of the American Heart Association 2023-08, Vol.12 (16), p.e030271-e030271
• Main Authors: Dobner, Stephan, Pilgrim, Thomas, Hagemeyer, Daniel, Heg, Dik, Lanz, Jonas, Reusser, Nicole, Gräni, Christoph, Afshar-Oromieh, Ali, Rominger, Axel, Langhammer, Bettina, Reineke, David, Windecker, Stephan, Stortecky, Stefan
• Format: Article
• Language: English
• Subjects: 99mTc‐DPD scintigraphy; aortic stenosis; cardiac amyloidosis; Original Research; TAVI; transthyretin
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.030271

Background The prevalence of calcific aortic stenosis and amyloid transthyretin cardiomyopathy (ATTR-CM) increase with age, and they often coexist. The objective was to determine the prevalence of ATTR-CM in patients with severe aortic stenosis and evaluate differences in presentations and outcomes of patients with concomitant ATTR-CM undergoing transcatheter aortic valve implantation. Methods and Results Prospective screening for ATTR-CM with Technetium -3,3-diphosphono-1,2-propanodicarboxylic acid bone scintigraphy was performed in 315 patients referred with severe aortic stenosis between August 2019 and August 2021. Myocardial Technetium -3,3-diphosphono-1,2-propanodicarboxylic acid tracer uptake was detected in 34 patients (10.8%), leading to a diagnosis of ATTR-CM in 30 patients (Perugini ≥2: 9.5%). Age (85.7±4.9 versus 82.8±4.5; =0.001), male sex (82.4% versus 57.7%; =0.005), and prior carpal tunnel surgery (17.6% versus 4.3%; =0.007) were associated with coexisting ATTR-CM, as were ECG (discordant QRS voltage to left ventricular wall thickness [42% versus 12%;