September 8, 2021Heart
Impact of afterload and infiltration on coexisting aortic stenosis and transthyretin amyloidosis
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Key result
Coexisting AS and ATTR linked to ~120% higher NT-proBNP levels versus AS alone.
- P=0.002
Why the study?
The impact of coexisting wild-type transthyretin cardiac amyloidosis and severe aortic stenosis on myocardial structure, function, and damage is unclear, posing diagnostic and management challenges.
Does the coexistence of ATTR and AS result in a phenotype more similar to ATTR or AS alone in terms of myocardial structure, function, and damage?
Population
Patients with severe AS undergoing TAVI with or without ATTR, patients with ATTR alone, and older age controls
Comparison
AS-ATTR phenotype vs AS alone vs ATTR alone vs older age controls
Design
Multicohort observational study using DPD scintigraphy for amyloidosis diagnosis
Authors
Discussion
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Implication
Supports ATTR-predominant myocardial injury in dual pathology; hypothesis-generating for ATTR-specific therapy benefit after AS intervention.
Study Design
Type
Cohort
Structured PICO
Does the coexistence of ATTR and AS result in a phenotype more similar to ATTR or AS alone in terms of myocardial structure, function, and damage?
P
Population
Patients with severe aortic stenosis undergoing TAVI evaluated for coexisting transthyretin cardiac amyloidosis using a multicohort approach.
C
Comparator
Older age controls, AS alone, and ATTR alone
O
Outcome
NT-pro Brain Natriuretic Peptide (BNP)surrogate
Main Result
Absolute Event Rate: 2844% vs 1294%
p-value: p=0.002
The AS-ATTR phenotype resembles ATTR more than AS alone, suggesting that ATTR-specific therapy may be beneficial even after AS treatment.
Cite This Study
Patel et al. (2021) conducted a cohort in Coexisting aortic stenosis and transthyretin amyloidosis. Coexisting aortic stenosis and transthyretin amyloidosis (AS-ATTR) vs. Aortic stenosis alone (AS) and ATTR alone was evaluated on NT-pro Brain Natriuretic Peptide (BNP) (p=0.002). Patients with coexisting aortic stenosis and transthyretin amyloidosis had significantly higher NT-proBNP levels (2844 ng/dL) compared to those with AS alone (1294 ng/dL; p=0.002).
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