RT Journal Article
SR Electronic
T1 1 A multi-centre study of cardiac amyloidosis in tavi patients
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP A15
OP A15
DO 10.1136/heartjnl-2018-BCVI.42
VO 104
IS Suppl 5
A1 Paul R Scully
A1 Thomas A Treibel
A1 Marianna Fontana
A1 Neil Hartman
A1 Guy Lloyd
A1 Francesca Pugliese
A1 Nikant Sabharwal
A1 Jim Newton
A1 Andrew Kelion
A1 Michael Mullen
A1 Muhiddin Ozkor
A1 Simon Kennon
A1 Leon J Menezes
A1 Philip N Hawkins
A1 James C Moon
YR 2018
UL http://heart.bmj.com/content/104/Suppl_5/A15.2.abstract
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.