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A recent study evaluated the prevalence of amyloid transthyretin cardiomyopathy in elderly patients with severe aortic stenosis. The results provide insights into the potential implications for those undergoing transcatheter aortic valve implantation.

  • Elderly patients with severe aortic stenosis may also present with amyloid transthyretin cardiomyopathy.
  • Echocardiography and invasive hemodynamics may help detect coexisting pathologies.
  • Concurrent amyloid transthyretin cardiomyopathy does not significantly alter adverse events or outcomes post-transcatheter aortic valve implantation.

According to a study published in the Journal of the American Heart Association, the prevalence of both calcific aortic stenosis and amyloid transthyretin cardiomyopathy (ATTR-CM) increases with age. Given the increasing occurrence of these conditions, there’s a notable overlap among elderly patients, specifically those undergoing transcatheter aortic valve implantation (TAVI). 

The goal of this study was to determine the prevalence of concurrent ATTR-CM in patients with aortic stenosis and evaluate the outcomes after TAVI.

Distinguishing Markers for Concurrent Pathologies

Specific markers may help distinguish patients with aortic stenosis who also have ATTR-CM. Advanced age, elevated levels of N‐terminal pro‐B‐type natriuretic peptide (NT-proBNP), and the need for loop diuretics were associated with ATTR-CM. Using echocardiography and invasive hemodynamics, disparities between patients with isolated aortic stenosis and those with both conditions became evident. For instance, lower left ventricular (LV) ejection fraction, increased LV wall thickness, and pulmonary hypertension were distinct indicators of concurrent ATTR-CM.

What Are the Effects on TAVI Outcomes?

Even when cardiac amyloid deposits are present, patients with severe and symptomatic aortic stenosis still benefit from undergoing TAVI. Moreover, even if ATTR-CM is also present, it doesn’t appear to greatly affect the results immediately after the procedure or up to 1 year following TAVI.

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Relevance for Healthcare Providers

For clinicians, an increased awareness of ATTR-CM in elderly patients with severe aortic stenosis may help guide pre-TAVI evaluations. While concomitant ATTR-CM doesn’t necessarily affect TAVI outcomes, awareness of potential overlaps can help support patient management and post-operative care. Practitioners may need to consider the potential influence of ATTR-CM, especially when evaluating elderly patients for TAVI.

Sources:

Dobner, S., Pilgrim, T., Hagemeyer, D., Heg, D., Lanz, J., Reusser, N., Gräni, C., Afshar‐Oromieh, A., Rominger, A., Langhammer, B., Reineke, D., Windecker, S., & Stortecky, S. (2023). Amyloid transthyretin cardiomyopathy in elderly patients with aortic stenosis undergoing transcatheter aortic valve implantation. Journal of the American Heart Association, 12(16). https://doi.org/10.1161/jaha.123.030271