Cardiac Amyloidosis as a Potential Risk Factor for Transapical Transcatheter Aortic Valve Implantation

Monticelli, Fabio; Kunz, Sebastian; Keller, Thomas; Bleiziffer, Sabine

doi:10.1111/jocs.12305

Cited by 17 publications

(19 citation statements)

References 4 publications

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“…Possible changes in clinical management could include minimizing bypass time during open valve surgery (eg, by using rapid deployment valves), switching to TAVR and influence the fundamental decision on medical management versus intervention. 29 Interestingly, perioperative mortality was not affected by the presence of wtATTR. In addition, although there are few systematic data, clinical experience has suggested avoiding calcium channel blockers and digoxin in the presence of cardiac amyloid.…”

Section: Implications For Management Of Asmentioning

confidence: 97%

Occult Transthyretin Cardiac Amyloid in Severe Calcific Aortic Stenosis

Treibel

Fontana

Gilbertson

et al. 2016

Circ: Cardiovascular Imaging

239

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Severe degenerative calcific aortic stenosis (cAS) is common, affecting 3% of individuals aged >75 years and leads to heart failure and death unless the valve is replaced.1,2 Its coexistence with cardiac amyloidosis has been reported, but this has not been studied systematically and the prognostic significance is unknown.3 Cardiac amyloidosis is a progressive infiltrative cardiomyopathy in which deposits of amyloid, almost always of either immunoglobulin light-chain (AL) or transthyretin amyloidosis (ATTR) type, 4-6 accumulate in the ventricular myocardium; ATTR amyloid is usually wildtype (wtATTR) and acquired, but it may also be hereditary and associated with mutant forms of transthyretin. Wild-type cardiac ATTR amyloid has a male preponderance and was formerly known as senile amyloid reflecting its first appearance beyond 60 to 70 years of age and prevalence at autopsy of up to 25% among octogenarians. 7,8 Its natural history and the prevalence of clinically significant ATTR amyloid deposition in the heart are unknown. In a recent small cohort of patients with AS who underwent transcatheter aortic valve Background-Calcific aortic stenosis (cAS) affects 3% of individuals aged >75 years, leading to heart failure and death unless the valve is replaced. Wild-type transthyretin cardiac amyloid is also a disorder of ageing individuals. Prevalence and clinical significance of dual pathology are unknown. This study explored the prevalence of wild-type transthyretin amyloid in cAS by myocardial biopsy, its imaging phenotype and prognostic significance. Methods and Results-A total of 146 patients with severe AS requiring surgical valve replacement underwent cardiovascular magnetic resonance and intraoperative biopsies; 112 had cAS (75±6 years; 57% men). Amyloid was sought histologically using Congo red staining and then typed using immunohistochemistry and mass spectrometry; patients with amyloid underwent clinical evaluation including genotyping and 99m TC-3,3-diphosphono-1,2-propanodicarboxylic-acid (DPD) bone scintigraphy. Amyloid was identified in 6 of 146 patients, all with cAS and >65 years (prevalence 5.6% in cAS >65). All 6 patients had wild-type transthyretin amyloid (mean age 75 years; range, 69-85; 4 men), not suspected on echocardiography. Cardiovascular magnetic resonance findings were of definite cardiac amyloidosis in 2, but could be explained solely by AS in the other 4. Postoperative DPD scans demonstrated cardiac localization in all 4 patients who had this investigation (2 died prior). At follow-up (median, 2.3 years), 50% with amyloid had died (versus 7.5% in cAS; 6.9% in age >65 years). In univariable analyses, the presence of transthyretin amyloidosis amyloid had the highest hazard ratio for death (9.5 [95% confidence interval, 2.5-35.8]; P=0.001). Conclusions-Occult wild-type transthyretin cardiac amyloid had a prevalence of 6% among patients with AS aged >65 years undergoing surgical aortic valve replacement and was associated with a poor outcome. (Circ Cardiovasc Imaging. 2016;9:e005066.

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Section: Implications For Management Of Asmentioning

confidence: 97%

Occult Transthyretin Cardiac Amyloid in Severe Calcific Aortic Stenosis

Treibel

Fontana

Gilbertson

et al. 2016

Circ: Cardiovascular Imaging

239

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“…8 Furthermore, management of these patients is a matter of discussion since they may benefit less from surgical (SAVR) or transcatheter aortic valve replacement (TAVR). 13 Present data on CA in AS patients largely rely on CMR, transthoracic echocardiography, and bone scintigraphy as diagnostic tools. 99m Tc-DPD bone scintigraphy allows for non-invasive detection of TTR-CA with high diagnostic sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

“…Coexisting CA in patients with AS has been reported to be associated with worse outcome 8 . Furthermore, management of these patients is a matter of discussion since they may benefit less from surgical (SAVR) or transcatheter aortic valve replacement (TAVR) 13 . Present data on CA in AS patients largely rely on CMR, transthoracic echocardiography, and bone scintigraphy as diagnostic tools.…”

Section: Introductionmentioning

confidence: 99%

Light‐chain and transthyretin cardiac amyloidosis in severe aortic stenosis: prevalence, screening possibilities, and outcome

Nitsche

Aschauer

Kammerlander

et al. 2020

European J of Heart Fail

131

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“…Thus, TAVR might be a better option for patients with intermediate to high surgical risk. However, since some patients might be prone to complications during TAVR because of the fragility of the infiltrated myocardium [108]. a multidisciplinary heart team should discuss the optimal therapy.…”

Section: Management Of Ttr Amyloidosis In Patients With Aortic Stenosismentioning

confidence: 99%

Cardiac Amyloidosis

Eötvös¹,

Paștiu²,

Zehan³

et al. 2021

Cardiomyopathy - Disease of the Heart Muscle

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Amyloidosis represents a heterogeneous group of disorders caused by amyloid fibril deposition in the extracellular space in different organs. Among the many types of amyloidosis cardiac involvement occurs almost exclusively with immunoglobulin light chain amyloidosis (AL amyloidosis) or transthyretin amyloidosis (ATTR amyloidosis). When present cardiac amyloidosis (CA) has a significant impact on disease prognosis. The typical clinical presentation in CA is that of a restrictive cardiomyopathy. Clinical suspicion of CA is based on clinical, laboratory and electrocardiographic findings. The diagnosis is confirmed using echocardiography, cardiac magnetic resonance imaging, biopsy, and/or bone scintigraphy. A precise definition of amyloidosis type is essential for choosing the specific treatment for this condition. Treatment of CA has two components: general treatment of congestive HF, and specific treatment of the underlying protein misfolding disorder.

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Cardiac Amyloidosis as a Potential Risk Factor for Transapical Transcatheter Aortic Valve Implantation

Cited by 17 publications

References 4 publications

Occult Transthyretin Cardiac Amyloid in Severe Calcific Aortic Stenosis

Occult Transthyretin Cardiac Amyloid in Severe Calcific Aortic Stenosis

Light‐chain and transthyretin cardiac amyloidosis in severe aortic stenosis: prevalence, screening possibilities, and outcome

Cardiac Amyloidosis

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