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

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.