What question did this study set out to answer?

To determine the prevalence, clinical characteristics, and echocardiographic predictors of transthyretin cardiac amyloidosis among elderly patients undergoing transcatheter aortic valve replacement for severe aortic stenosis.

June 6, 2017European Heart JournalOpen Access

Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

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Why the study?

What is the prevalence of transthyretin cardiac amyloidosis and its echocardiographic predictors among elderly patients with severe aortic stenosis undergoing TAVR?

Key Points

To determine the prevalence, clinical characteristics, and echocardiographic predictors of transthyretin cardiac amyloidosis among elderly patients undergoing transcatheter aortic valve replacement for severe aortic stenosis.
Assessed elderly patients presenting with severe calcific aortic stenosis scheduled for transcatheter aortic valve replacement (TAVR).
Evaluated clinical and echocardiographic features, including tissue Doppler mitral annular S' velocity, alongside confirmatory 99mTc-PYP scintigraphy for transthyretin cardiac amyloidosis (ATTR-CA).
Transthyretin cardiac amyloidosis was identified in 16% of patients with severe calcific aortic stenosis undergoing TAVR.
The presence of ATTR-CA was significantly associated with a low-flow, low-gradient severe aortic stenosis phenotype and mildly reduced ejection fraction.
An average tissue Doppler mitral annular S' velocity of < 6 cm/s demonstrated utility as a sensitive clinical indicator warranting confirmatory 99mTc-PYP scanning.

Structured PICO

What is the prevalence of transthyretin cardiac amyloidosis and its echocardiographic predictors among elderly patients with severe aortic stenosis undergoing TAVR?

Population

Elderly patients with severe calcific aortic stenosis undergoing transcatheter aortic valve replacement (TAVR)

Outcome

Prevalence of transthyretin cardiac amyloidosis (ATTR-CA) and identification of echocardiographic predictors

ATTR-CA is present in 16% of elderly patients undergoing TAVR for severe AS, and a tissue Doppler mitral annular S' < 6 cm/s should prompt confirmatory testing for amyloidosis.

Implication

May prompt targeted ATTR-CA testing in low-flow low-gradient severe AS before TAVR; leaves open outcome impact and need for prospective validation.

Abstract

Transthyretin cardiac amyloidosis is prevalent in 16% of patients with severe calcific AS undergoing TAVR and is associated with a severe AS phenotype of low-flow low-gradient with mildly reduced ejection fraction. Average tissue Doppler mitral annular S' of < 6 cm/s may be a sensitive measure that should prompt a confirmatory 99mTc-PYP scan and subsequent testing for ATTR-CA. Prospective assessment of outcomes after TAVR is needed in patients with and without ATTR-CA.