Key result
Concomitant cardiac amyloidosis does not affect 1-year mortality in severe aortic stenosis patients undergoing TAVI.
Why the study?
Severe aortic stenosis and cardiac amyloidosis frequently coexist in elderly populations, but the prognostic significance of dual pathology in the context of TAVI is not widely established.
Does concomitant cardiac amyloidosis impact 1-year all-cause mortality in patients with severe aortic stenosis?
Does concomitant cardiac amyloidosis impact 1-year all-cause mortality in patients with severe aortic stenosis?
The presence of concomitant cardiac amyloidosis does not significantly worsen 1-year all-cause mortality in patients with severe aortic stenosis, including those undergoing TAVI.
Concomitant cardiac amyloidosis does not increase 1-year mortality after TAVI; leaves open whether screening or targeted therapies alter outcomes in CA-AS.
Background Severe aortic stenosis (AS) and cardiac amyloidosis (CA) frequently coexist in elderly populations. The prognostic significance of dual pathology CA-AS in the context of transcatheter aortic valve implantation (TAVI) is not widely established. We performed a systematic review and meta-analysis to compare 1-year mortality of patients with concomitant CA-AS to those with isolated AS. Background PubMed, EMBASE, Web of Science and Cochrane databases were searched until February 16th 2025 for all multivariable-adjusted or propensity-matched observational studies evaluating clinical outcomes in CA-AS patients. Summary odds ratios with 95% confidence intervals (CI) were calculated using random-effects model, with pre-specified subgroup analyses for patients undergoing TAVI. Results Fifteen observational studies (775319 severe AS patients) met inclusion criteria. The mean follow-up duration was 22.4 months, mean age was 81.5 years and 56.3% were men. The pooled odds ratio for all-cause mortality in CA-AS patients was 1.21 (95% CI 0.81-1.80). There was no statistically significant difference in 1-year all-cause mortality between CA-AS and isolated AS (OR 1.38, 95% CI 0.80-2.37) or between CA-AS patients undergoing TAVI compared to medical management (OR 0.94, 95% CI 0.56-1.58). Conclusion The presence of concomitant CA does not significantly impact the 1-year all-cause mortality of patients with severe AS undergoing TAVI.Figure 1:Pooled OR (95% CI) CA-AS Figure 2:TAVI vs Medical (CA-AS)
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Zaka et al. (2025) studied this question. Concomitant cardiac amyloidosis did not significantly affect 1-year all-cause mortality in severe aortic stenosis patients undergoing TAVI (OR 0.94, 95% CI 0.56-1.58).
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