Cardiac amyloidosis prevalence and 1-year outcome in patients with aortic stenosis undergoing transaortic valve implantation: Findings from the CAMPOS-TAVI study

• Published in: Archives of cardiovascular diseases 2024-08, Vol.117 (8-9), p.461-469
• Main Authors: Costa, Jérôme, El-Ali, Ahmed, Morland, David, Dejust, Sebastien, Papathanassiou, Dimitri, Nazeyrollas, Pierre, Metz, Damien
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial - complications; Amyloid Neuropathies, Familial - diagnosis; Amyloid Neuropathies, Familial - diagnostic imaging; Amyloid Neuropathies, Familial - epidemiology; Amyloid Neuropathies, Familial - mortality; Amyloid Neuropathies, Familial - surgery; Amyloid transthyretin cardiomyopathy; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Bone scintigraphy; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - epidemiology; Cardiomyopathies - mortality; Cardiomyopathies - physiopathology; Female; Heart failure; Human health and pathology; Humans; Life Sciences; Male; Prevalence; Prospective Studies; Risk Assessment; Risk Factors; Severe aortic stenosis; Time Factors; Transaortic valve implantation; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome
• ISSN: 1875-2136; 1875-2128; 1875-2128
• DOI: 10.1016/j.acvd.2024.04.007

[Display omitted] •One in 14 patients (7%) with severe AS undergoing TAVI diagnosed with ATTR-CM.•Targeted screening with Tc99m BS in those at risk (red flags and/or risk scores).•Monoclonal gammopathy excluded.•Emphasis on tailored management for patients with positive BS.•Management includes consideration of TTR stabilizers.•Continued surveillance for ATTR-CM in high-risk patients with negative BS.•More studies needed to define impact of ATTR-CM on long-term prognosis after TAVI. Transthyretin amyloid cardiomyopathy (ATTR-CM) can manifest as rhythm disorders, heart failure, but also valvular degeneration. Despite aortic stenosis (AS) being prevalent among the elderly, data on ATTR-CM prevalence and outcome in patients with AS undergoing transaortic valve implantation (TAVI) remain scarce. To determine ATTR-CM prevalence and evaluate 1-year survival in patients undergoing TAVI. Between December 2020 and September 2021, 100 consecutive patients underwent TAVI and were screened prospectively for ATTR-CM using bone scintigraphy (BS). Monoclonal gammopathy was ruled out in case of cardiac uptake on BS. All patients were followed prospectively for 1year after TAVI. The proportion of patients aged≥75years or with a EuroSCORE II>8% and possible femoral access was 99%. The abnormal cardiac uptake rate on BS was 7% (95% confidence interval: 2–12%); 86% of these patients were male. The RAISE (remodelling, age, injury, system and electrical) score, indicative of ATTR-CM risk, was higher in case of positive BS (P=0.04). Patients with positive BS were older and exhibited wider QRS complexes on electrocardiography (P=0.003), a higher frequency of reduced LVEF (57% vs. 17%), impaired basal LV strain (P=0.02) and a lower voltage/mass ratio (P=0.01). History of pacemaker implantation before TAVI was higher in the positive BS group (P=0.0004) and remained the only statistically significant factor after adjustment using the Holm–Bonferroni method. One-year survival of patients with positive BS did not differ from that of patients with isolated AS. Prevalence of ATTR-CM in patients treated with TAVI, underscoring the need for continued surveillance for potential development of ATTR-CM after TAVI. Caution is warranted regarding the 1-year survival because of the lack of study power. Further investigations are needed to define long-term prognosis of AS with ATTR-CM.