Key result
Cardiac amyloidosis in AS is linked to ~130% higher mortality, especially with moderate-to-severe LVH.
Why the study?
Cardiac amyloidosis has been increasingly recognized in elderly patients with aortic stenosis, but whether concurrent cardiac amyloidosis portends excess mortality was uncertain.
Does concurrent cardiac amyloidosis increase all-cause mortality in elderly patients with aortic stenosis?
Does concurrent cardiac amyloidosis increase all-cause mortality in elderly patients with aortic stenosis?
Concurrent cardiac amyloidosis significantly increases the risk of all-cause death in elderly patients with aortic stenosis, particularly in those with moderate to severe left ventricular hypertrophy.
Concurrent cardiac amyloidosis may identify higher-risk aortic stenosis; extends small observational cohorts but leaves prospective validation open.
Funding Acknowledgements Type of funding sources: None. Background Cardiac amyloidosis (CA) has been increasingly recognized in elderly patients with aortic stenosis (AS), but with uncertain prognostic significance. Objectives We performed a systematic review and meta-analysis to clarify whether concurrent CA portends excess mortality in patients with aortic stenosis AS. Methods Our systematic review of the literature published through June 2020, sought observational studies reporting summary-level outcome data of all-cause mortality in AS patients with or without concurrent CA. Pooled estimate of Mantel-Haenszel odds ratio (OR) and 95% confidence intervals (CIs) for all-cause death was assessed as the primary endpoint. We performed subgroup analysis stratified by severity of left ventricular hypertrophy (LVH) and study-level meta-regression analysis to explore the effect of covariates on summary effect size and to address statistical heterogeneity. Results We identified 4 studies including 609 AS patients (9% AS-CA; 69% men; age, 84 ± 5 years). The average follow-up was 20 ± 5 months. Compared with lone AS, AS-CA was associated with 2-fold increase in all-cause mortality (pooled OR: 2.30; 95% CI: 1.02-5.18; I2 = 62%). When analysed according to LVH severity, pooled ORs (95% CI) for all-cause mortality were 1.29 (0.65-2.22) for mild LVH (≤16 mm), and 4.81 (2.19-10.56) for moderate/severe LVH (>16 mm). Meta-regression analysis confirmed a stronger relationship proportional to the degree of LVH, regardless of age and aortic valve replacement, explaining between-study heterogeneity variance. Conclusions CA heralds significantly higher risk of all-cause death in elderly patients with AS. Severity of LVH appears to be a major prognostic determinant in patients with dual AS-CA pathology. Abstract Figure.
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Ricci et al. (2021) studied this question. Cardiac amyloidosis in aortic stenosis patients is associated with a 2.30-fold increase in all-cause mortality, especially in those with moderate/severe left ventricular hypertrophy.
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