Suspicion of Cardiac Amyloidosis Not Associated With Death in Aortic Stenosis

The level of suspicion of concomitant cardiac amyloidosis (CA) in patients with severe aortic stenosis (AS) does not play a significant role in predicting all-cause mortality following aortic valve replacement, according to study results presented at the American College of Cardiology (ACC) 2023 conference, held from March 4 to 6, 2023, in New Orleans, Louisiana.

Investigators sought to assess the prevalence of and outcomes in patients with a probable or highly-probable CA diagnosis who subsequently received transcatheter (TAVR) or surgical aortic valve replacement (SAVR). To identify patients with CA, the investigators used echocardiographic “red flags,” defined as the presence of an interventricular septal thickening of 13 mm or more that was associated with at least 1 (probable CA) or 2 (highly-probable CA) of the following criteria: mitral stenosis of less than 6 cm/s, a right ventricular wall thickening of 5 mm or more, a pericardial effusion, or a myocardial granular sparkling.

This retrospective study included 2 cohorts of patients (N=2066; mean age, 74 years; 42% women) with severe AS between 2002 and 2018. Mean follow-up in the TAVR cohort (n=770) was 2.3 years and 2.9 years in the SAVR cohort (n=1296).

The TAVR cohort had 88 patients (11.4%) with probable CA and 67 patients (8.7%) with highly-probable CA. All-cause mortality in this cohort was similar across all groups (probable CA, 35.2%; highly-probable CA, 38.8%; no CA, 33.7%; P =.69).

The SAVR cohort had 167 patients (12.9%) with probable CA and 84 patients (6.5%) with highly-probable CA. All-cause mortality in this cohort was similar across all groups (probable CA, 12.0%; highly-probable CA, 14.3%; no CA, 10.7%; P =.56).

The investigators found no association between suspicion of CA and all-cause mortality in both cohorts, analyzed separately or combined, using Cox regression survival analysis adjusted for covariates.