Cardiac amyloidosis prevalence and 1-year outcome in patients with aortic stenosis undergoing transaortic valve implantation: Findings from the CAMPOS-TAVI study

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2024-08-01 DOI:10.1016/j.acvd.2024.04.007

Jérôme Costa , Ahmed El-Ali , David Morland , Sebastien Dejust , Dimitri Papathanassiou , Pierre Nazeyrollas , Damien Metz

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Abstract

Background

Transthyretin amyloid cardiomyopathy (ATTR-CM) can manifest as rhythm disorders, heart failure, but also valvular degeneration. Despite aortic stenosis (AS) being prevalent among the elderly, data on ATTR-CM prevalence and outcome in patients with AS undergoing transaortic valve implantation (TAVI) remain scarce.

Aim

To determine ATTR-CM prevalence and evaluate 1-year survival in patients undergoing TAVI.

Methods

Between December 2020 and September 2021, 100 consecutive patients underwent TAVI and were screened prospectively for ATTR-CM using bone scintigraphy (BS). Monoclonal gammopathy was ruled out in case of cardiac uptake on BS. All patients were followed prospectively for 1 year after TAVI.

Results

The proportion of patients aged ≥ 75 years or with a EuroSCORE II > 8% and possible femoral access was 99%. The abnormal cardiac uptake rate on BS was 7% (95% confidence interval: 2–12%); 86% of these patients were male. The RAISE (remodelling, age, injury, system and electrical) score, indicative of ATTR-CM risk, was higher in case of positive BS (P = 0.04). Patients with positive BS were older and exhibited wider QRS complexes on electrocardiography (P = 0.003), a higher frequency of reduced LVEF (57% vs. 17%), impaired basal LV strain (P = 0.02) and a lower voltage/mass ratio (P = 0.01). History of pacemaker implantation before TAVI was higher in the positive BS group (P = 0.0004) and remained the only statistically significant factor after adjustment using the Holm–Bonferroni method. One-year survival of patients with positive BS did not differ from that of patients with isolated AS.

Conclusions

Prevalence of ATTR-CM in patients treated with TAVI, underscoring the need for continued surveillance for potential development of ATTR-CM after TAVI. Caution is warranted regarding the 1-year survival because of the lack of study power. Further investigations are needed to define long-term prognosis of AS with ATTR-CM.

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接受经主动脉瓣植入术的主动脉瓣狭窄患者的心脏淀粉样变性发病率和 1 年预后：CAMPOS-TAVI研究结果

转甲状腺素淀粉样变性心肌病（ATTR-CM）可表现为心律失常、心力衰竭和瓣膜退化。尽管主动脉瓣狭窄（AS）在老年人中很普遍，但有关接受经主动脉瓣植入术（TAVI）的ATTR-CM患病率和AS患者预后的数据仍然很少。目的：确定ATTR-CM的患病率，并评估接受TAVI手术患者的1年生存率。2020年12月至2021年9月期间，100名患者连续接受了TAVI手术，并通过骨闪烁成像（BS）对ATTR-CM进行了前瞻性筛查。如果 BS 出现心脏摄取，则排除单克隆抗体病。所有患者在 TAVI 术后均接受了为期一年的前瞻性随访。年龄≥75岁或EuroSCORE II>8%且有可能进入股动脉的患者比例为99%。BS的心脏摄取异常率为7%（95%置信区间：2-12%）；其中86%为男性患者。显示 ATTR-CM 风险的 RAISE（重塑、年龄、损伤、系统和电气）评分在 BS 阳性的患者中更高（=0.04）。BS 阳性的患者年龄更大，心电图上的 QRS 波群更宽（=0.003），LVEF 降低的频率更高（57% 对 17%），左心室基础应变受损（=0.02），电压/质量比更低（=0.01）。BS 阳性组患者在 TAVI 术前植入起搏器的历史较长（=0.0004），在使用 Holm-Bonferroni 方法进行调整后，该因素仍是唯一具有统计学意义的因素。BS 阳性患者的一年生存率与孤立的 AS 患者没有差异。在接受 TAVI 治疗的患者中，ATTR-CM 的发病率很高，这强调了在 TAVI 术后继续监测 ATTR-CM 潜在发展的必要性。由于研究力量不足，对1年存活率的评估需谨慎。还需要进一步的研究来确定患有 ATTR-CM 的 AS 的长期预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.