August 5, 2020JACC. Cardiovascular imaging134 citationsOpen Access
View Full PaperIdentifying Cardiac Amyloid in Aortic Stenosis
Structured PICO
Do measures of interstitial expansion (ECV, voltage/mass ratio) improve the detection of cardiac amyloid in patients with aortic stenosis compared to conventional parameters?
P
Population
Elderly patients referred for transcatheter aortic valve replacement (TAVR) with aortic stenosis
I
Intervention
Measures of interstitial expansion (extracellular volume [ECV] and voltage/mass ratio)
C
Comparator
Conventional electrocardiogram and echocardiography parameters
O
Outcome
Detection of cardiac amyloidsurrogate
Measures of interstitial expansion, such as the voltage/mass ratio, provide high diagnostic utility for detecting cardiac amyloidosis in patients with aortic stenosis, outperforming conventional ECG and echocardiography.
Abstract
OBJECTIVES: ) as part of routine evaluation for the detection of cardiac amyloid in patients with aortic stenosis (AS)-amyloid. BACKGROUND: AS-amyloid affects 1 in 7 elderly patients referred for transcatheter aortic valve replacement (TAVR). Bone scintigraphy with exclusion of a plasma cell dyscrasia can diagnose transthyretin-related cardiac amyloid noninvasively, for which novel treatments are emerging. Amyloid interstitial expansion increases the myocardial extracellular volume (ECV). METHODS: performed using the 5-min post-contrast acquisition. RESULTS: Tc-3,3-diphosphono-1,2-propanodicarboxylic acid Perugini grade 2 only), outperforming conventional electrocardiogram and echocardiography parameters. One composite parameter, the voltage/mass ratio, had utility (similar AUC of 0.87 for any cardiac amyloid detection), although in one-third of patients, this could not be calculated due to bundle branch block or ventricular paced rhythm. CONCLUSIONS: tracks the degree of infiltration. Another measure of interstitial expansion, the voltage/mass ratio, also performed well.