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. 2025 Aug;12(4):2467-2476.
doi: 10.1002/ehf2.15258. Epub 2025 Mar 11.

Transthyretin amyloid cardiomyopathy in aortic stenosis patients scheduled for transcatheter aortic valve implantation

Margrethe Flesvig Holt  1   2 , August Flø  1   2   3 , Esra Kaya  1   2 , Sophie Foss Kløve  1 , Hege Martinsen  4 , Kristine Amlie  4 , Petter Storsten  4 , Thomas Misje Mathiisen  4 , Kristoffer Russell  1 , Christian Hesbø Eek  1 , Helge Skulstad  1   2   5 , Melinda Raki  6 , Lars Gullestad  1   2   3 , Anders Hodt  4 , Einar Gude  1 , Kaspar Broch  1   2   3
Affiliations

Transthyretin amyloid cardiomyopathy in aortic stenosis patients scheduled for transcatheter aortic valve implantation

Margrethe Flesvig Holt et al. ESC Heart Fail. 2025 Aug.

Abstract

Aims: The prevalences of aortic stenosis (AS) and transthyretin amyloid cardiomyopathy (ATTR-CM) increase with age. Identification of occult ATTR-CM in patients with AS can help explain out-of-proportion myocardial dysfunction, aid in prognostication and prompt initiation of disease-modifying treatment. Studies have suggested that many patients referred for transcatheter aortic valve implantation (TAVI) have concomitant ATTR-CM, but some have included unverified ATTR-CM in patients with ambiguous scintigrams. We aimed to assess the co-occurrence of ATTR-CM in patients scheduled for TAVI.

Methods: In patients accepted for TAVI for severe AS, we used bone scintigraphy to screen for ATTR-CM. We defined ATTR-CM as a cardiac tracer uptake ≥ Perugini Grade 2 in the absence of abnormal monoclonal protein or abnormal free light chain ratio. We offered bioptic verification to patients with Grade 1 or ambiguous DPD uptake.

Results: We included 171 consecutive patients aged 79 ± 7 years, 57% were male. Six patients (3.5%) had cardiac bone tracer uptake ≥ Perugini Grade 2 and no abnormal monoclonal protein/free light chains. Endomyocardial biopsies confirmed the diagnosis in two additional patients (1.2%), whereas five patients with low-grade uptake did not have ATTR-CM. In total, 8/171 patients (4.7%) were diagnosed with concomitant AS and ATTR-CM. Most of the patients with concomitant ATTR-CM had low-flow low-gradient (LFLG) AS, and 25% had a history of carpal tunnel syndrome.

Conclusions: We found concomitant AS and ATTR-CM in 5% of our TAVI patients. Carpal tunnel syndrome and LFLG AS suggest concomitant ATTR.

Keywords: ATTR‐CM; TAVI; aortic stenosis; bone scintigraphy; cardiac amyloidosis; endomyocardial biopsy.

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Conflict of interest statement

Dr. Gullestad has received lecture fees from AstraZeneca, Boehringer Ingelheim and Novartis and has sat on advisory boards for AstraZeneca and Boehringer Ingelheim. Dr. Broch has received lecture fees and consulting fees from Pfizer and has sat on advisory boards for AstraZeneca, Pharmacosmos, Boehringer Ingelheim and Pfizer. Dr. Gude has received grants and honoraria for lectures from Pfizer and has sat on advisory boards for Pfizer. Dr. Hodt has received honoraria for lectures from Pfizer. The remaining authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of the study population. AS, aortic stenosis; AVR, aortic valve replacement; TAVI, transcatheter aortic valve implantation.
See this image and copyright information in PMC

References

    1. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic‐valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363:1597‐1607. doi: 10.1056/NEJMoa1008232 - DOI - PubMed
    1. Thourani VH, Jensen HA, Babaliaros V, Kodali SK, Rajeswaran J, Ehrlinger J, et al. Outcomes in nonagenarians undergoing transcatheter aortic valve replacement in the PARTNER‐I trial. Ann Thorac Surg 2015;100:785‐792. doi: 10.1016/j.athoracsur.2015.05.021 - DOI - PubMed
    1. Osnabrugge RL, Arnold SV, Reynolds MR, Magnuson EA, Wang K, Gaudiani VA, et al. Health status after transcatheter aortic valve replacement in patients at extreme surgical risk: results from the CoreValve U.S. trial. JACC Cardiovasc Interv 2015;8:315‐323. doi: 10.1016/j.jcin.2014.08.016 - DOI - PMC - PubMed
    1. Gilstrap LG, Dominici F, Wang Y, El‐Sady MS, Singh A, Di Carli MF, et al. Epidemiology of cardiac amyloidosis‐associated heart failure hospitalizations among fee‐for‐service Medicare beneficiaries in the United States. Circ Heart Fail 2019;12:e005407. doi: 10.1161/CIRCHEARTFAILURE.118.005407 - DOI - PMC - PubMed
    1. Bloom MW, Gorevic PD. Cardiac amyloidosis. Ann Intern Med 2023;176:Itc33‐itc48. doi: 10.7326/AITC202303210 - DOI - PubMed

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