Suspected Cardiac Amyloidosis in Patients with Severe Aortic Stenosis Receiving Trans-catheter Aortic Valve Replacement

Abstract

Objective: Some patients with severe aortic stenosis (AS) have cardiac amyloidosis. However, its prevalence and clinical implications, particularly in Japanese patients receiving transcatheter aortic valve replacement (TAVR), remain unknown. Methods: Patients who received 99m Tc-pyrophosphate ( 99m Tc-PYP) scintigraphy tests before TAVR were prospectively included. No patients had any unique symptoms or signs associated with cardiac amyloidosis. Clinical data were compared between those with scintigraphy positive and those without. Results: Among the 102 patients (median age 85 years, 30% men), 5 patients (5%) showed positive deposits in the 99m Tc-PYP scintigraphy tests. There were no statistically significant differences in the baseline and post-TAVR clinical parameters including the severity of AS between the two groups. Following TAVR, plasma B-type natriuretic peptide and cardiac hypertrophy remained unchanged in the scintigraphy-positive group, whereas they improved in the scintigraphy-negative group. Post-TAVR heart failure readmission rate was higher in the scintigraphy-positive group (0.182 versus 0.058 events per year, p = 0.064). Conclusion:The existence of suspected cardiac amyloidosis might be associated with inadequate cardiac unloading and persistent cardiac hypertrophy following TAVR in the Japanese cohort.