Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation
Autor: | Kush Patel, Sucharitha Chadalavada, Andrew Kelion, Francesca Pugliese, Marianna Fontana, Philip N. Hawkins, Paul Scully, Nikant Sabharwal, Thomas A. Treibel, Leon Menezes, Muhiddin Ozkor, James C. Moon, Michael J. Mullen, Neil Hartman, George Thornton, Guy Lloyd, Michail Katsoulis, Simon Kennon, Rebecca K. Hughes, James D. Newton |
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Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_specialty medicine.drug_class Population 030204 cardiovascular system & hematology Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Prevalence medicine Natriuretic peptide Humans 030212 general & internal medicine education Aged Aged 80 and over Heart Valve Prosthesis Implantation education.field_of_study Troponin T medicine.diagnostic_test business.industry Amyloidosis Aortic Valve Stenosis medicine.disease Stenosis Treatment Outcome Bone scintigraphy Cardiac amyloidosis Aortic Valve Aortic valve stenosis Quality of Life Cardiology Female Tomography X-Ray Computed Cardiology and Cardiovascular Medicine Complication business |
Zdroj: | European Heart Journal. 41:2759-2767 |
ISSN: | 1522-9645 0195-668X |
Popis: | Aims Cardiac amyloidosis is common in elderly patients with aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI). We hypothesized that patients with dual aortic stenosis and cardiac amyloid pathology (AS-amyloid) would have different baseline characteristics, periprocedural and mortality outcomes. Methods and results Patients aged ≥75 with severe AS referred for TAVI at two sites underwent blinded bone scintigraphy prior to intervention (Perugini Grade 0 negative, 1–3 increasingly positive). Baseline assessment included echocardiography, electrocardiogram (ECG), blood tests, 6-min walk test, and health questionnaire, with periprocedural complications and mortality follow-up. Two hundred patients were recruited (aged 85 ± 5 years, 50% male). AS-amyloid was found in 26 (13%): 8 Grade 1, 18 Grade 2. AS-amyloid patients were older (88 ± 5 vs. 85 ± 5 years, P = 0.001), with reduced quality of life (EQ-5D-5L 50 vs. 65, P = 0.04). Left ventricular wall thickness was higher (14 mm vs. 13 mm, P = 0.02), ECG voltages lower (Sokolow–Lyon 1.9 ± 0.7 vs. 2.5 ± 0.9 mV, P = 0.03) with lower voltage/mass ratio (0.017 vs. 0.025 mV/g/m2, P = 0.03). High-sensitivity troponin T and N-terminal pro-brain natriuretic peptide were higher (41 vs. 21 ng/L, P Conclusions AS-amyloid is common and differs from lone AS. Transcatheter aortic valve implantation significantly improved outcome in AS-amyloid, while periprocedural complications and mortality were similar to lone AS, suggesting that TAVI should not be denied to patients with AS-amyloid. |
Databáze: | OpenAIRE |
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