Valvulopatías significativas en amiloidosis por transtiretina wild-type: prevalencia e impacto en la sobrevida

Objective. There are limited data on the prevalence and prognostic impact of significant valvular heart disease in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt). The aim of this study was to describe the prevalence of aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR) in this population and, secondarily, to evaluate their impact on survival. Methods. This was a retrospective, single-center cohort study including patients diagnosed with ATTRwt between 2011 and 2024. We calculated the prevalence of each significant valvular heart disease, and Kaplan-Meier survival curves were generated to estimate two-year all-cause mortality, stratified according to the presence or absence of each significant valvular disease. Finally, a multivariable Cox regression was performed to assess their association with survival. Results. We included 154 patients, with a mean age of 81 (±7) years; 85% (n=131) were male. Significant TR was the most prevalent valvular disease (27%, n=41), followed by significant MR (20%, n=30) and AS (13%, n=20). Patients with significant TR had a higher incidence of all-cause mortality compared to those without significant TR (41% vs. 16%, log-rank test, p=0.0007), whereas no differences were observed between patients with and without significant AS or MR. In multivariable Cox models, significant TR was independently associated with higher mortality, regardless of age, the presence of other valvular diseases, and NT-proBNP levels. Conclusions. Significant TR was the most prevalent valvular disease in patients with ATTRwt and was associated with lower survival in this population.