Evaluation of aortic valve calcification in patients with suspected cardiac amyloidosis

Background The association between transthyretin cardiac amyloidosis (TTR-CA) and aortic stenosis (AS) has been described, although the mechanism by which they interact remains unclear. It has previously been proposed that this may be secondary to excess valvular calcification. Objectives We propose that patients with suspected cardiac amyloidosis will have increased aortic valve calcification, as evidenced by elevated aortic valve calcium score on CT imaging. Methods We retrospectively identified patients with severe AS referred for transcatheter aortic valve implantation (TAVI) from January 2017 to November 2022. This population was divided into two cohorts; the Likely CA cohort had suspected TTR-CA by echocardiogram while the Unlikely CA cohort did not. Baseline characteristics, echocardiographic data, CT aortic valve calcium scores, and post-procedural complications were compared. Results Of the 496 patients analyzed, 145 (29.2%) patients met echocardiographic criteria (interventricular septal thickness (IVS) ≥1.2 cm and average mitral annular systolic s’ ≤ 6 cm/s) for the Likely CA cohort. The Likely CA cohort was more likely to be older, be male, have atrial fibrillation, and have worse renal function. On echocardiogram, the Likely CA cohort had increased hypertrophy, worsened diastolic function, and decreased systolic function. Aortic valve calcium score by CT was not significantly different between the Likely CA and Unlikely CA cohort (2834.95 AU compared to 2852.27 AU, p=0.914). There was no statistically significant difference in post-TAVI complications. Conclusions Patients with an echocardiographic profile consistent with TTR-CA had no difference in aortic valve calcification in comparison to a population unlikely to have TTR-CA.