Cardiac AMyloïdosis Prevalence and Outcome in aortic Stenosis patients undergoing Transcatheter Aortic Valve Implantation: First insight of the CAMPOS-TAVI study - 28/12/21
, A. El Ali 1, N. Semaan 1, C. Barbe 2, P. Nazeyrollas 1, 2, 3, D. Morland 3, 4, S. Dejust 4, D. Papathanassiou 3, 4, D. Metz 1, 2, 3
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Résumé |
Background |
Cardiac amyloïdosis (CA) is an emerging disease in cardiology, especially the transthyretine form (TTR) in the elderly. However, data regarding prevalence of TTR-CA in patients with severe aortic stenosis (AS) remain scarce.
Purpose |
To precise the prevalence of TTR-CA in patients refered for transcatheter aortic valve implantation (TAVI).
Methods |
All patients undergoing TAVI for severe AS between December 2020 and April 2021 in our center were screened for CA, using bone scintigraphy (BS) with HDP-99mTc before or after TAVI procedure. Cardiac fixation was ranked according to Perugini score (from 0 to III). Patients with Perugini score ≥I on BS underwent seric and urine assay to rule out light chain amyloïdosis.
Results |
Among the 50 patients included so far, mean age was 82 ±5.4 years, and 32 (64%) were male. Mean LVEF was 57 ±10%. Mean EuroScore II was 4.0 ±3.1, 42 (84%) had femoral access and 9 (18%) had already pacemaker (Table 1). Abnormal cardiac fixation on BS was observed in 4 patients (8.0%): 3 had Perugini I and 1 Perugini II. All were males. These 4 patients presented more abnormal cardiac parameters on ECG and echocardiography, such as: longer PR delay (208±56 versus 151±81ms), wider QRS (143±31 versus 113±24ms, P=0.03) (Figure 1B), lower ejection fraction (49±9 versus 58±10%) (Figure 1A), higher left ventricule mass index (LVMi) (134 ±13 versus 120 ±34g/m2) (Figure 1C), lower voltage (1.45 versus 2.2mV, P=0.08) and lower voltage/mass ratio (11 ±2 versus 20 ±10μV/g/m2, P=0.07) (Figure 1D). Patients with positive BS tend to have higher pacemaker implantation before TAVI (50% versus 15%, P=0.08).
Conclusion |
Prevalence of TTR-CA was 8.0% in our population of AS patients treated with TAVI. All were male sex, and had more frequent conduction disorders, higher LVMi, lower LVEF and lower VMR. Those preliminary results need to be consolidated with the study completion.
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Vol 14 - N° 1
P. 34-35 - janvier 2022 Retour au numéro
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