Cardiac amyloidosis prevalence and 1-year outcome in patients with aortic stenosis undergoing transaortic valve implantation: Findings from the CAMPOS-TAVI study - 17/08/24
, Ahmed El-Ali a, David Morland b, c, d, Sebastien Dejust b, Dimitri Papathanassiou b, c, d, Pierre Nazeyrollas a, e, Damien Metz aGraphical abstract |
Highlights |
• | 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. |
Abstract |
Background |
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.
Aim |
To determine ATTR-CM prevalence and evaluate 1-year survival in patients undergoing TAVI.
Methods |
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.
Results |
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.
Conclusions |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Amyloid transthyretin cardiomyopathy, Severe aortic stenosis, Transaortic valve implantation, Bone scintigraphy, Heart failure
Plan
| ☆ | Tweet: Exploring transthyretin cardiac amyloidosis (ATTR-CM) in TAVI patients with low to high risk (CAMPOS-TAVI): Study finds 7% prevalence using bone scintigraphy. No difference in 1-year mortality rates; importance of targeted screening and surveillance for timely ATTR-CM detection and management. #Amyloidosis #AorticStenosis #TAVI #HeartFailure. |
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