What question did this study set out to answer?

The study aims to establish a simple screening method for cardiac amyloidosis in patients with aortic stenosis to prevent disease progression.

April 24, 2026

Screening for amyloidosis before aortic valve elective replacement: results from the SAVER study

Key Result

A holistic screening approach identified cardiac amyloidosis in 2% of aortic stenosis patients, utilizing predictors like male sex and carpal tunnel syndrome to achieve an AUC of 0.88.

Key Points

The study aims to establish a simple screening method for cardiac amyloidosis in patients with aortic stenosis to prevent disease progression.
Prospective cohort study with 1001 aortic stenosis patients planned for valve replacement.
Assessment included symptoms, history, and imaging techniques like DPD scintigraphy and MRI.
Multiple-regression analysis identified predictors of cardiac amyloidosis risk.
40% of patients flagged for potential cardiac amyloidosis, with 21% proceeding to further diagnostics.
Only 2% confirmed cases of cardiac amyloidosis were identified.
Key predictors included male sex, carpal tunnel syndrome, and elevated NT-proBNP levels.

Structured PICO

Does a holistic screening approach based on multiorgan manifestations accurately identify cardiac amyloidosis in patients with aortic stenosis planned for valve replacement?

Population

1001 patients with aortic stenosis planned for transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR)

Intervention

SAVER screening approach (assessment for cardiac amyloidosis-specific symptoms and history, followed by DPD scintigraphy or magnetic resonance imaging if suspected)

Outcome

Identification of optimal parameters for selecting patients at risk of cardiac amyloidosis and diagnostic performance (AUC)surrogate

A holistic screening approach incorporating clinical symptoms, NT-proBNP, and echocardiographic features provides high diagnostic accuracy (AUC 0.88) for detecting concomitant cardiac amyloidosis in patients undergoing aortic valve replacement.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Aims Concomitant aortic stenosis (AS) and cardiac amyloidosis (CA) result in heart failure and reduced life expectancy. Early detection of CA in AS is an unmet clinical need to prevent disease progression. The SAVER study aims to establish a simple CA screening for AS patients. Methods and results SAVER is a prospective cohort study enrolling AS patients planned for transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Firstly, patients were assessed for CA-specific symptoms and history on top of AS evaluation. Patients with suspected CA underwent DPD scintigraphy or magnetic resonance imaging. Secondly, we performed multiple-regression analysis to identify optimal parameters for selecting patients at risk of CA. From 2021 to 2023, 1001 patients were enrolled, with 405 (40%) flagged for potential CA. Two hundred six (21%) patients received further diagnostics due to the screening and five (0.5%) patients due to physician discretion, leading to 17 (2%) confirmed CA cases. Key predictors of CA included male sex OR 23.8 (95% CI 2.6; 216.9), carpal tunnel syndrome OR 5.5 (95% CI 1.4; 22.0), spinal stenosis OR 4.1 (95% CI 1.1; 14.7), heaviness or numbness of arms or legs OR 3.8 (95% CI 1.1; 13.3), NT-proBNP OR 6.7 (95% CI 1.8; 25.3), and sparkling myocardium OR 4.8 (95% CI 1.3; 17.3). The optimized approach reached an AUC of 0.88 (95% CI 0.81–0.96). Conclusion The SAVER approach is the first holistic screening method focusing on CA’s multiorgan manifestations in AS. This approach can be implemented in clinical settings to prevent futile outcomes of combined disease.

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