Why the study?
There is growing evidence of the coexistence of aortic stenosis and transthyretin cardiac amyloidosis, and failing to screen these patients during clinical visits represents a lost opportunity.
Does the presence of concomitant cardiac amyloidosis increase all-cause mortality and worsen clinical and imaging parameters in patients with clinically significant aortic stenosis?
Does the presence of concomitant cardiac amyloidosis increase all-cause mortality and worsen clinical and imaging parameters in patients with clinically significant aortic stenosis?
Cardiac amyloidosis is highly prevalent (11%) in patients with clinically significant aortic stenosis and is associated with worse structural remodeling, higher biomarkers, and increased mortality, highlighting the need for routine screening.
Background: There is growing evidence of coexistence of aortic stenosis (AS) and transthyretin cardiac amyloidosis (CA). Not screening AS patients at the time of hospital/clinic visit for CA represents a lost opportunity. Methods: We surveyed studies that reported the prevalence of CA among AS patients. Studies that compared patients with aortic stenosis with cardiac amyloidosis (AS-CA) and AS alone were further analyzed, and meta-regression was performed. Results: We identified nine studies with 1,321 patients of AS, of which 131 patients had concomitant CA, with a prevalence of 11%. When compared to AS-alone, the patients with AS-CA were older, more likely to be males, had higher prevalence of carpal tunnel syndrome, right bundle branch block. On echocardiogram, patients with AS-CA had thicker interventricular septum, higher left ventricular mass index (LVMI), lower myocardial contraction fraction, and lower stroke volume index. Classical low-flow low-gradient (LFLG) physiology was more common among patients with AS-CA. Patients with AS-CA had higher all-cause mortality than patients with AS alone (33% vs. 22%, P = 0.02) in a follow-up period of at least 1 year. Conclusions: CA has a high prevalence in patients with AS and is associated with worse clinical, imaging, and biochemical parameters than patients with AS alone.
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Arshad et al. (2022) studied this question.
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