PT  - JOURNAL ARTICLE
AU  - Paul R Scully
AU  - Thomas A Treibel
AU  - Marianna Fontana
AU  - Neil Hartman
AU  - Guy Lloyd
AU  - Francesca Pugliese
AU  - Nikant Sabharwal
AU  - Jim Newton
AU  - Andrew Kelion
AU  - Michael Mullen
AU  - Muhiddin Ozkor
AU  - Simon Kennon
AU  - Leon J Menezes
AU  - Philip N Hawkins
AU  - James C Moon
TI  - 1 A multi-centre study of cardiac amyloidosis in tavi patients
AID  - 10.1136/heartjnl-2018-BCVI.42
DP  - 2018 May 01
TA  - Heart
PG  - A15--A15
VI  - 104
IP  - Suppl 5
4099  - http://heart.bmj.com/content/104/Suppl_5/A15.2.short
4100  - http://heart.bmj.com/content/104/Suppl_5/A15.2.full
SO  - Heart2018 May 01; 104
AB  - Background Aortic stenosis (AS) is common, affecting nearly 3% of those aged over 75. Once symptomatic with severe AS outcomes are poor without intervention. An under-recognised restrictive cardiomyopathy in the elderly is wild-type transthyretin amyloid, with deposits found in up to 25% of those aged over 85 at autopsy. Bone scintigraphy offers a reliable non-invasive method of diagnosis. Dual pathology is likely to be an important disease modifier in the elderly undergoing transcatheter aortic valve implantation (TAVI).Methods This work forms part of the ATTRact-AS multi-centre study (NCT03029026), which seeks the prevalence of cardiac amyloid in the elderly (aged ≥75) with severe AS referred for TAVI. Participants underwent 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scintigraphy prior to TAVI, which was graded using the Perugini scoring system. All DPD-positive patients were referred onto the National Amyloidosis Centre.Results 125 patients were recruited between October 2016 and January 2018 (aged 86±5 years, 44% male). At baseline the aortic valve peak velocity was 4.19±0.66 m/s, mean gradient 43±15 mmHg and area 0.40±0.11 cm2. Left ventricular ejection fraction was 53%±11% and mean septal wall thickness 13±2 mm (range 6–21 mm). DPD scintigraphy was positive in 16 patients (13%, 95% CI: 8% to 20%). Perugini grade was 1 (n=5) and 2 (n=11). In the DPD-positive cohort 44% were male (aged 88±5 years) and those genotyped were all wild-type (n=7).Discussion We have built on the recently published interim results of the ATTRact-AS study. Our findings from two centres suggest that 13% of elderly patients referred for TAVI with AS have occult cardiac amyloidosis.