Prognostic Significance of Cardiac Amyloidosis in Patients With Aortic Stenosis

Ricci, Fabrizio; Ceriello, Laura; Khanji, Mohammed Y; Dangas, George; Bucciarelli-Ducci, Chiara; Mauro, Michele Di; Fedorowski, Artur; Zimarino, Marco; Gallina, Sabina

doi:10.1016/j.jcmg.2020.07.011

Cited by 25 publications

(20 citation statements)

References 5 publications

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“…A variation in LV GLS should reduce correlation with tracer uptake compared to those in sinus rhythm, and although 15% of the study cohort was in atrial fibrillation, the overall correlation with tracer uptake was strong. Aortic stenosis has been previously demonstrated to be associated with cardiac ATTR, which can also impact some echocardiographic parameters (30,31). However, in the study group only one patient had mild aortic stenosis in the cardiac ATTR group and unlikely to make a significant impact on the outcomes.…”

Section: Discussionmentioning

confidence: 70%

Correlation Between Quantitative Uptake of 99mTC-DPD and Echocardiographic Parameters in Cardiac ATTR: A Novel Follow-Up Strategy

Harapoz

Evans

Geenty

et al. 2021

Front. Cardiovasc. Med.

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Aims: There has been a paradigm shift in diagnosis of cardiac transthyretin amyloidosis (ATTR) with non-invasive techniques including technetium-99m 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) bone scintigraphy. We evaluated structural and functional biventricular alterations by transthoracic echocardiography (TTE) and determined the correlation with 99mTc-DPD tracer uptake in ATTR.Materials and Methods: ATTR patients (wild-type, hereditary or asymptomatic transthyretin [TTR] variant carriers) with 99mTc-DPD and TTE were selected; 99mTc-DPD uptake was analyzed quantitatively. TTE assessment of left ventricle (LV) and right ventricle (RV) parameters was performed.Results: Forty ATTR patients (wild-type n = 17; hereditary ATTR and TTR variant carriers n = 23; median age 68.8 ± 22 years) were included. TTE parameters displaying good correlation with 99mTc-DPD tracer uptake included LV average wall thickness (r = 0.837), LV indexed mass (LVMI; r = 0.802), RV wall thickness (r = 0.610), average e' (r = −0.830), E/e' ratio (r = 0.786), LV global longitudinal strain (GLS; r = 0.714) and RV GLS (r = 0.632; p < 0.001 for all). Hereditary ATTR and TTR variant carriers without cardiac tracer uptake had normal echocardiographic parameters. Receiver operating characteristic curves demonstrated strong diagnostic accuracies for structural (LV wall thickness, LVMI and RV wall thickness; area under the curve (AUC) of 0.96 for all) and functional (LV and RV GLS; AUC of 0.86 and 0.88, respectively) parameters.Conclusion: Good correlations between TTE biventricular structural and functional parameters were demonstrated with quantitative 99mTc-DPD uptake. Echocardiography may potentially assume a significant role in longitudinal follow-up for monitoring disease progression and for evaluating treatment response.

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Section: Discussionmentioning

confidence: 70%

Correlation Between Quantitative Uptake of 99mTC-DPD and Echocardiographic Parameters in Cardiac ATTR: A Novel Follow-Up Strategy

Harapoz

Evans

Geenty

et al. 2021

Front. Cardiovasc. Med.

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“…When present, the disease may mimic a variety of other cardiac illnesses, such as hypertrophic cardiomyopathy, left ventricular hypertrophy of any cause, heart failure with preserved ejection fraction, or hypertensive heart disease. Cardiac amyloidosis may even coexist with aortic stenosis 1 and other patients with new‐onset atrial fibrillation 2 . In this editorial, we discuss the role of left ventricular speckle‐tracking echocardiography in the assessment of cardiac amyloidosis (CA) in reference to the original work published in this issue of the journal 3 …”

Section: Measures Values Authors (References)mentioning

confidence: 99%

“…As shown in Figure 1, bi‐atrial and right ventricular strain may provide useful diagnostic measures complementing the standard echo‐Doppler data. All the suggested cardiac comorbidities associated with CA, such as aortic stenosis, 1 atrial fibrillation, 2 and heart failure with preserved ejection fraction, have been shown to have diagnostic values using bi‐atrial and right ventricular strain 13 …”

Section: Measures Values Authors (References)mentioning

confidence: 99%

Echocardiographic diagnosis of cardiac amyloidosis: Does the masquerader require only a "cherry on top"?

et al. 2020

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“…However, a different prevalence could be also explained by some specific patient's characteristics, in particular age and gender (6,7). Two recent meta-analyses report a prevalence of CA in patient with AS of 9 and 14.4%, respectively (8,9). Thus, the true prevalence of CA in patients with AS is still undefined and probably underestimated in some studies.…”

Section: Introductionmentioning

confidence: 99%

Red Flags, Prognostic Impact, and Management of Patients With Cardiac Amyloidosis and Aortic Valve Stenosis: A Systematic Review and Meta-Analysis

et al. 2022

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BackgroundCardiac amyloidosis (CA) has been recently recognized as a condition frequently associated with aortic stenosis (AS). The aim of this study was to evaluate: the main characteristics of patients with AS with and without CA, the impact of CA on patients with AS mortality, and the effect of different treatment strategies on outcomes of patients with AS with concomitant CA.Materials and MethodsA detailed search related to CA in patients with AS and outcomes was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies enrolling 1,988 subjects (1,658 AS alone and 330 AS with CA) were included in the qualitative and quantitative analysis of main patients with AS characteristics with and without CA, difference in mortality, and treatment strategy.ResultsThe prevalence of CA resulted in a mean of 15.4% and it was even higher in patients with AS over 80 years old (18.2%). Patients with the dual diagnosis were more often males, had lower body mass index (BMI), were more prone to have low flow, low gradient with reduced left ventricular ejection fraction AS phenotype, had higher E/A and E/e', and greater interventricular septum hypertrophy. Lower Sokolow–Lyon index, higher QRS duration, higher prevalence of right bundle branch block, higher levels of N-terminal pro-brain natriuretic peptide, and high-sensitivity troponin T were significantly associated with CA in patients with AS. Higher overall mortality in the 178 patients with AS + CA in comparison to 1,220 patients with AS alone was observed [odds ratio (OR) 2.25, p = 0.004]. Meta-regression analysis showed that younger age and diabetes were associated with overall mortality in patients with CS with CA (Z-value −3.0, p = 0.003 and Z-value 2.5, p = 0.013, respectively). Finally, patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) had a similar overall mortality risk, but lower than medication-treated only patients.ConclusionResults from our meta-analysis suggest that several specific clinical, electrocardiographic, and echocardiographic features can be considered “red flags” of CA in patients with AS. CA negatively affects the outcome of patients with AS. Patients with concomitant CA and AS benefit from SAVR or TAVI.

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Prognostic Significance of Cardiac Amyloidosis in Patients With Aortic Stenosis

Cited by 25 publications

References 5 publications

Correlation Between Quantitative Uptake of 99mTC-DPD and Echocardiographic Parameters in Cardiac ATTR: A Novel Follow-Up Strategy

Correlation Between Quantitative Uptake of 99mTC-DPD and Echocardiographic Parameters in Cardiac ATTR: A Novel Follow-Up Strategy

Echocardiographic diagnosis of cardiac amyloidosis: Does the masquerader require only a "cherry on top"?

Red Flags, Prognostic Impact, and Management of Patients With Cardiac Amyloidosis and Aortic Valve Stenosis: A Systematic Review and Meta-Analysis

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