Hannah Rosenblum1, Ahmad Masri2, David L Narotsky1, Jeff Goldsmith3, Nadira Hamid4, Rebecca T Hahn4, Susheel Kodali4, Torsten Vahl4, Tamim Nazif4, Omar K Khalique4, Sabahat Bokhari5, Prem Soman6, João L Cavalcante7, Mathew S Maurer1, Adam Castaño1,3. 1. Center for Cardiac Amyloidosis, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA. 2. The Amyloidosis Center, Division of Cardiology, Oregon Health & Sciences University, Portland, OR, USA. 3. Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA. 4. Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA. 5. Laboratory of Nuclear Cardiology, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA. 6. Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburg, PA, USA. 7. Cardiovascular Imaging Research Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
Abstract
AIMS: Advances in diagnostic imaging have increased the recognition of coexisting transthyretin cardiac amyloidosis (ATTR-CA) and severe aortic stenosis (AS), with a reported prevalence between 8-16%. In this prospective study, we aimed to evaluate the implications of ATTR-CA on outcomes after transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: At two academic centres, we screened patients with severe AS undergoing TAVR for ATTR-CA. Using Kaplan-Meier analysis, we compared survival free from death and a combined endpoint of death and first heart failure hospitalization between patients with and without ATTR-CA. Cox proportional-hazards models were used to determine the association of ATTR-CA with these endpoints. The rate of heart failure hospitalization was compared amongst those with and without ATTR-CA. Overall, 204 patients (83 years, 65% male, Society of Thoracic Surgeons score 6.6%, 72% New York Heart Association class III/IV) were included, 27 (13%) with ATTR-CA. Over a median follow-up of 2.04 years, there was no difference in mortality (log rank, P = 0.99) or the combined endpoint (log rank, P = 0.79) between patients with and without ATTR-CA. In Cox proportional-hazards models, the presence of ATTR-CA was not associated with death. However, patients with ATTR-CA had increased rates of heart failure hospitalization at 1 year (0.372 vs. 0.114 events/person-year, P < 0.004) and 3 years (0.199 vs. 0.111 events/person-year, P = 0.087) following TAVR. CONCLUSION: In moderate-risk patients with severe AS undergoing TAVR, there was a 13% prevalence of ATTR-CA, which did not affect mortality. The observed increase in heart failure hospitalization following TAVR in those with ATTR-CA suggests the consequences of the underlying infiltrative myopathy.
AIMS: Advances in diagnostic imaging have increased the recognition of coexisting transthyretin cardiac amyloidosis (ATTR-CA) and severe aortic stenosis (AS), with a reported prevalence between 8-16%. In this prospective study, we aimed to evaluate the implications of ATTR-CA on outcomes after transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: At two academic centres, we screened patients with severe AS undergoing TAVR for ATTR-CA. Using Kaplan-Meier analysis, we compared survival free from death and a combined endpoint of death and first heart failure hospitalization between patients with and without ATTR-CA. Cox proportional-hazards models were used to determine the association of ATTR-CA with these endpoints. The rate of heart failure hospitalization was compared amongst those with and without ATTR-CA. Overall, 204 patients (83 years, 65% male, Society of Thoracic Surgeons score 6.6%, 72% New York Heart Association class III/IV) were included, 27 (13%) with ATTR-CA. Over a median follow-up of 2.04 years, there was no difference in mortality (log rank, P = 0.99) or the combined endpoint (log rank, P = 0.79) between patients with and without ATTR-CA. In Cox proportional-hazards models, the presence of ATTR-CA was not associated with death. However, patients with ATTR-CA had increased rates of heart failure hospitalization at 1 year (0.372 vs. 0.114 events/person-year, P < 0.004) and 3 years (0.199 vs. 0.111 events/person-year, P = 0.087) following TAVR. CONCLUSION: In moderate-risk patients with severe AS undergoing TAVR, there was a 13% prevalence of ATTR-CA, which did not affect mortality. The observed increase in heart failure hospitalization following TAVR in those with ATTR-CA suggests the consequences of the underlying infiltrative myopathy.
Authors: Pranav Chandrashekar; Laith Alhuneafat; Meghan Mannello; Lana Al-Rashdan; Morris M Kim; Jason Dungu; Kevin Alexander; Ahmad Masri Journal: Circ Genom Precis Med Date: 2021-08-31
Authors: Christian Nitsche; Paul R Scully; Kush P Patel; Andreas A Kammerlander; Matthias Koschutnik; Carolina Dona; Tim Wollenweber; Nida Ahmed; George D Thornton; Andrew D Kelion; Nikant Sabharwal; James D Newton; Muhiddin Ozkor; Simon Kennon; Michael Mullen; Guy Lloyd; Marianna Fontana; Philip N Hawkins; Francesca Pugliese; Leon J Menezes; James C Moon; Julia Mascherbauer; Thomas A Treibel Journal: J Am Coll Cardiol Date: 2020-11-09 Impact factor: 24.094
Authors: Oscar Westin; Marie D Lauridsen; Søren Lund Kristensen; Lars Køber; Christian Torp-Pedersen; Gunnar Gislason; Lars Søndergaard; Mathew S Maurer; Birgitte Pernille Leicht; Finn Gustafsson; Emil L Fosbøl Journal: Int J Cardiol Heart Vasc Date: 2021-03-08