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

被引：99

作者：

Nitsche, Christian ^{[1
]}

Aschauer, Stefan ^{[1
]}

Kammerlander, Andreas A. ^{[1
]}

Schneider, Matthias ^{[1
]}

Poschner, Thomas ^{[1
]}

Duca, Franz ^{[1
]}

Binder, Christina ^{[1
]}

Koschutnik, Matthias ^{[1
]}

Stiftinger, Julian ^{[1
]}

Goliasch, Georg ^{[1
]}

Siller-Matula, Jolanta ^{[1
]}

Winter, Max-Paul ^{[1
]}

Anvari-Pirsch, Anahit ^{[1
]}

Andreas, Martin ^{[2
]}

Geppert, Alexander ^{[3
]}

Beitzke, Dietrich ^{[4
]}

Loewe, Christian ^{[4
]}

Hacker, Marcus ^{[5
]}

Agis, Hermine ^{[6
]}

Kain, Renate ^{[7
]}

Lang, Irene ^{[1
]}

Bonderman, Diana ^{[1
]}

Hengstenberg, Christian ^{[1
]}

Mascherbauer, Julia ^{[1
]}

机构：

[1] Med Univ Vienna, Dept Internal Med 2, Div Cardiol, Waehringer Guertel 18-20, A-1090 Vienna, Austria

[2] Med Univ Vienna, Dept Cardiac Surg, Vienna, Austria

[3] Wilhelminenspital Stadt Wien, Dept Internal Med 3, Div Cardiol, Vienna, Austria

[4] Med Univ Vienna, Dept Cardiovasc & Intervent Radiol, Dept Radiol, Vienna, Austria

[5] Med Univ Vienna, Dept Nucl Med, Vienna, Austria

[6] Med Univ Vienna, Div Oncol, Dept Internal Med 1, Vienna, Austria

[7] Med Univ Vienna, Dept Pathol, Vienna, Austria

来源：

EUROPEAN JOURNAL OF HEART FAILURE | 2020年 / 22卷 / 10期

关键词：

Aortic stenosis; Cardiac amyloidosis; Transcatheter aortic valve replacement; Screening; Prognosis; EUROPEAN ASSOCIATION; DIAGNOSIS; ECHOCARDIOGRAPHY; RECOMMENDATIONS; HEART; SCINTIGRAPHY; CARDIOLOGY;

D O I：

10.1002/ejhf.1756

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Concomitant cardiac amyloidosis (CA) in severe aortic stenosis (AS) is difficult to recognize, since both conditions are associated with concentric left ventricular thickening. We aimed to assess type, frequency, screening parameters, and prognostic implications of CA in AS. Methods and results A total of 191 consecutive AS patients (81.2 +/- 7.4 years; 50.3% female) scheduled for transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Overall, 81.7% underwent complete assessment including echocardiography with strain analysis, electrocardiography (ECG), cardiac magnetic resonance imaging (CMR), Tc-99m-DPD scintigraphy, serum and urine free light chain measurement, and myocardial biopsy in immunoglobulin light chain (AL)-CA. Voltage/mass ratio (VMR; Sokolow-Lyon index on ECG/left ventricular mass index) and stroke volume index (SVi) were tested as screening parameters. Receiver operating characteristic curve, binary logistic regression, and Kaplan-Meier curve analyses were performed. CA was found in 8.4% of patients (n = 16); 15 had transthyretin (TTR)-CA and one AL-CA. While global longitudinal strain by echo did not reliably differentiate AS from CA-AS [area under the curve (AUC) 0.643], VMR as well as SVi showed good discriminative power (AUC 0.770 and 0.773, respectively), which was comparable to extracellular volume by CMR (AUC 0.756). Also, VMR and SVi were independently associated with CA by multivariate logistic regression analysis (P = 0.016 and P = 0.027, respectively). CA did not significantly affect survival 15.3 +/- 7.9 months after TAVR (P = 0.972). Conclusion Both TTR- and AL-CA can accompany severe AS. Parameters solely based on ECG and echocardiography allow for the identification of the majority of CA-AS. In the present cohort, CA did not significantly worsen prognosis 15.3 months after TAVR.

引用

页码：1852 / 1862

页数：11

共 35 条

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