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Fan Q, Zhang Y, Ling Y. A review regarding the article 'Prevalence of Valvular Heart Disease in Cardiac Amyloidosis and Impact on Survival'. Curr Probl Cardiol 2024; 49:102574. [PMID: 38653443 DOI: 10.1016/j.cpcardiol.2024.102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/20/2024] [Indexed: 04/25/2024]
Abstract
Cardiac amyloidosis (CA) is a condition characterized by the accumulation of amyloid fibrils in the heart muscle, resulting in an infiltrative cardiomyopathy. The presence of amyloid protein can impact different parts of the heart, including the valves. Limited data is available on the prevalence and prognostic significance of valvular heart disease (VHD) in CA. However, advancements in imaging technology have allowed for accurate noninvasive diagnosis of CA, eliminating the need for confirmatory endomyocardial biopsy and improving our understanding of this dual pathology. The development of targeted drug therapies for CA and transcatheter valve replacement or repair for VHD has significantly improved the prognosis for patients with both conditions. This review will discuss the findings of this original research and provide an overview of current researches on VHD in CA, as well as the progress in diagnosing and treating CA with VHD.
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Affiliation(s)
- Qiang Fan
- Department of Cardiovascular Surgery, West China Hopital of Sichuan University, Sichuan, China
| | - Yuanyuan Zhang
- Department of Cardiovascular Surgery, West China Hopital of Sichuan University, Sichuan, China
| | - Yunfei Ling
- Department of Cardiovascular Surgery, West China Hopital of Sichuan University, Sichuan, China.
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Beuthner BE, Elkenani M, Evert K, Mustroph J, Jacob CF, Paul NB, Beißbarth T, Zeisberg EM, Schnelle M, Puls M, Hasenfuß G, Toischer K. Histological assessment of cardiac amyloidosis in patients undergoing transcatheter aortic valve replacement. ESC Heart Fail 2024; 11:1636-1646. [PMID: 38407567 PMCID: PMC11098657 DOI: 10.1002/ehf2.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/28/2023] [Accepted: 01/19/2024] [Indexed: 02/27/2024] Open
Abstract
AIMS Studies have reported a strongly varying co-prevalence of aortic stenosis (AS) and cardiac amyloidosis (CA). We sought to histologically determine the co-prevalence of AS and CA in patients undergoing transcatheter aortic valve replacement (TAVR). Consequently, we aimed to derive an algorithm to identify cases in which to suspect the co-prevalence of AS and CA. METHODS AND RESULTS In this prospective, monocentric study, endomyocardial biopsies of 162 patients undergoing TAVR between January 2017 and March 2021 at the University Medical Centre Göttingen were analysed by one pathologist blinded to clinical data using haematoxylin-eosin staining, Elastica van Gieson staining, and Congo red staining of endomyocardial biopsies. CA was identified in only eight patients (4.9%). CA patients had significantly higher N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (4356.20 vs. 1938.00 ng/L, P = 0.034), a lower voltage-to-mass ratio (0.73 vs. 1.46 × 10-2 mVm2/g, P = 0.022), and lower transaortic gradients (Pmean 17.5 vs. 38.0 mmHg, P = 0.004) than AS patients. Concomitant CA was associated with a higher prevalence of post-procedural acute kidney injury (50.0% vs. 13.1%, P = 0.018) and sudden cardiac death [SCD; P (log-rank test) = 0.017]. Following propensity score matching, 184 proteins were analysed to identify serum biomarkers of concomitant CA. CA patients expressed lower levels of chymotrypsin (P = 0.018) and carboxypeptidase 1 (P = 0.027). We propose an algorithm using commonly documented parameters-stroke volume index, ejection fraction, NT-proBNP levels, posterior wall thickness, and QRS voltage-to-mass ratio-to screen for CA in AS patients, reaching a sensitivity of 66.6% with a specificity of 98.1%. CONCLUSIONS The co-prevalence of AS and CA was lower than expected, at 4.9%. Despite excellent 1 year mortality, AS + CA patients died significantly more often from SCD. We propose a multimodal algorithm to facilitate more effective screening for CA containing parameters commonly documented during clinical routine. Proteomic biomarkers may yield additional information in the future.
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Affiliation(s)
- Bo Eric Beuthner
- Department of Cardiology and PneumologyUniversity Medical Centre Göttingen, Georg August University of GöttingenRobert‐Koch‐Straße 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Manar Elkenani
- Department of Cardiology and PneumologyUniversity Medical Centre Göttingen, Georg August University of GöttingenRobert‐Koch‐Straße 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Katja Evert
- Institute of PathologyUniversity of RegensburgRegensburgGermany
| | - Julian Mustroph
- Department of Internal Medicine IIUniversity Medical Centre RegensburgRegensburgGermany
| | - Christoph Friedemann Jacob
- Department of Cardiology and PneumologyUniversity Medical Centre Göttingen, Georg August University of GöttingenRobert‐Koch‐Straße 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Niels Benjamin Paul
- Department of Cardiology and PneumologyUniversity Medical Centre Göttingen, Georg August University of GöttingenRobert‐Koch‐Straße 4037075GöttingenGermany
- Department of Medical BioinformaticsUniversity Medical Centre Göttingen, Georg August University of GöttingenGöttingenGermany
| | - Tim Beißbarth
- Department of Medical BioinformaticsUniversity Medical Centre Göttingen, Georg August University of GöttingenGöttingenGermany
| | - Elisabeth Maria Zeisberg
- Department of Cardiology and PneumologyUniversity Medical Centre Göttingen, Georg August University of GöttingenRobert‐Koch‐Straße 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Moritz Schnelle
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
- Department of Clinical ChemistryUniversity Medical Centre Göttingen, Georg August University of GöttingenGöttingenGermany
| | - Miriam Puls
- Department of Cardiology and PneumologyUniversity Medical Centre Göttingen, Georg August University of GöttingenRobert‐Koch‐Straße 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Gerd Hasenfuß
- Department of Cardiology and PneumologyUniversity Medical Centre Göttingen, Georg August University of GöttingenRobert‐Koch‐Straße 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Karl Toischer
- Department of Cardiology and PneumologyUniversity Medical Centre Göttingen, Georg August University of GöttingenRobert‐Koch‐Straße 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
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Yun S, Casado J, Pérez-Silvestre J, Salamanca P, Llàcer P, Quirós R, Ruiz-Hueso R, Méndez M, Manzano L, Formiga F. Clinical suspicion, diagnosis and management of cardiac amyloidosis: update document and executive summary. Rev Clin Esp 2024; 224:288-299. [PMID: 38614320 DOI: 10.1016/j.rceng.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the "red flags" to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.
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Affiliation(s)
- S Yun
- Bio-Heart Cardiovascular Diseases Research Group, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Atención a la Insuficiencia Cardíaca Comunitaria, Servicios de Cardiología y Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
| | - J Pérez-Silvestre
- Servicio de Medicina Interna, UMIPIC, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - P Salamanca
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - P Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - R Quirós
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Spain; RICAPPS, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Spain
| | - R Ruiz-Hueso
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M Méndez
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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4
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Fatima K, Uddin QS, Tharwani ZH, Kashif MAB, Javaid SS, Kumar P, Zia MT, Javed M, Butt MS, Asim Z. Concomitant transthyretin cardiac amyloidosis in patients undergoing TAVR for aortic stenosis: A systemic review and meta-analysis. Int J Cardiol 2024; 402:131854. [PMID: 38367883 DOI: 10.1016/j.ijcard.2024.131854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/15/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Transcatheter aortic valve replacement (TAVR) is a successful treatment for aortic stenosis (AS) patients, and previous studies indicate favorable outcomes for those with concomitant aortic stenosis and transthyretin-associated cardiac amyloidosis (TTRCA-AS). However, the impact of TAVR on more adverse outcomes in TTRCA-AS patients compared to those with AS alone is still uncertain, with conflicting findings reported in the literature. METHODS PubMed and Scopus were extensively searched from inception till August 2021. Studies were included if they reported data for prevalence and outcomes including mortality and cardiovascular-related hospitalization events in TTRCA-AS patients referred for TAVR. The data for these outcomes were pooled using a random effects model and forest plots were created. RESULTS After initially screening 146 articles, 6 were shortlisted for inclusion in our analysis. Pooled analysis demonstrated a 13.3% [95% CI: 10.9-16.5; p = 0.307] prevalence of TTRCA in patients with AS undergoing TAVR. The incidence of mortality and cardiovascular (CV) hospitalization in patients with TTRCA-AS undergoing TAVR were 28.3% [95% CI: 18.7-39.0, p = 0.478] and 21.1% [95% CI: 10.2-34.5, p = 0.211], respectively. CONCLUSION The overall pooled TTRCA-AS prevalence was reported to be 13.3% in AS patients who underwent TAVR. Furthermore, transthyretin-associated CA was found to be associated with an increased risk of mortality and hospitalization. Large patient population studies are required to assess the safety and efficacy of TAVR in TTRCA-AS patients, as current research report data from small patient cohorts.
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Affiliation(s)
- Kaneez Fatima
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Qazi Shurjeel Uddin
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Syed Sarmad Javaid
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Prince Kumar
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Twaha Zia
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Maarij Javed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Malaika Saeed Butt
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Zoraiz Asim
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
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5
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Pereyra Pietri M, Farina JM, Mahmoud AK, Scalia IG, Galasso F, Killian ME, Suppah M, Kenyon CR, Koepke LM, Padang R, Chao CJ, Sweeney JP, Fortuin FD, Eleid MF, Sell-Dottin KA, Steidley DE, Scott LR, Fonseca R, Lopez-Jimenez F, Attia ZI, Dispenzieri A, Grogan M, Rosenthal JL, Arsanjani R, Ayoub C. The prognostic value of artificial intelligence to predict cardiac amyloidosis in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:295-302. [PMID: 38774378 PMCID: PMC11104461 DOI: 10.1093/ehjdh/ztae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 05/24/2024]
Abstract
Aims Cardiac amyloidosis (CA) is common in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Cardiac amyloidosis has poor outcomes, and its assessment in all TAVR patients is costly and challenging. Electrocardiogram (ECG) artificial intelligence (AI) algorithms that screen for CA may be useful to identify at-risk patients. Methods and results In this retrospective analysis of our institutional National Cardiovascular Disease Registry (NCDR)-TAVR database, patients undergoing TAVR between January 2012 and December 2018 were included. Pre-TAVR CA probability was analysed by an ECG AI predictive model, with >50% risk defined as high probability for CA. Univariable and propensity score covariate adjustment analyses using Cox regression were performed to compare clinical outcomes between patients with high CA probability vs. those with low probability at 1-year follow-up after TAVR. Of 1426 patients who underwent TAVR (mean age 81.0 ± 8.5 years, 57.6% male), 349 (24.4%) had high CA probability on pre-procedure ECG. Only 17 (1.2%) had a clinical diagnosis of CA. After multivariable adjustment, high probability of CA by ECG AI algorithm was significantly associated with increased all-cause mortality [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.01-1.96, P = 0.046] and higher rates of major adverse cardiovascular events (transient ischaemic attack (TIA)/stroke, myocardial infarction, and heart failure hospitalizations] (HR 1.36, 95% CI 1.01-1.82, P = 0.041), driven primarily by heart failure hospitalizations (HR 1.58, 95% CI 1.13-2.20, P = 0.008) at 1-year follow-up. There were no significant differences in TIA/stroke or myocardial infarction. Conclusion Artificial intelligence applied to pre-TAVR ECGs identifies a subgroup at higher risk of clinical events. These targeted patients may benefit from further diagnostic evaluation for CA.
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Affiliation(s)
- Milagros Pereyra Pietri
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Juan M Farina
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Ahmed K Mahmoud
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Isabel G Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Francesca Galasso
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Michael E Killian
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Courtney R Kenyon
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Laura M Koepke
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - John P Sweeney
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - F David Fortuin
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - David E Steidley
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Luis R Scott
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Rafael Fonseca
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | | | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Grogan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Julie L Rosenthal
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Porcari A, Sinagra G, Gillmore JD, Fontana M, Hawkins PN. Breakthrough advances enhancing care in ATTR amyloid cardiomyopathy. Eur J Intern Med 2024; 123:29-36. [PMID: 38184468 DOI: 10.1016/j.ejim.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Transthyretin amyloid cardiomyopathy (ATTR-CM) has been traditionally considered a rare and inexorably fatal condition. ATTR-CM now is an increasingly recognized cause of heart failure (HF) and mortality worldwide with effective pharmacological treatments. Advances in non-invasive diagnosis, coupled with the development of effective treatments, have transformed the diagnosis of ATTR-CM, which is now possible without recourse to endomyocardial biopsy in ≈70 % of cases. Many patients are now diagnosed at an earlier stage. Echocardiography and cardiac magnetic resonance have enabled identification of patients with possible ATTR-CM and more accurate prognostic stratification. Although radionuclide scintigraphy with 'bone' tracers has an established diagnostic value, the diagnostic performance of the bone tracers validated for non-invasive confirmation of ATTR-CM may not be equal. Characterising the wider clinical phenotype of patients with ATTR-CM has enabled identification of features with potential for earlier diagnosis such as carpal tunnel syndrome. Therapies able to slow or halt ATTR-CM progression and increase survival are now available and there is also evidence that patients may benefit from specific conventional HF medications. Cutting-edge research in the field of antibody-mediated removal of ATTR deposits compellingly suggest that ATTR-CM is a truly reversible disorder, bringing hope for patients even with advanced disease. A wide horizon of possibilities is unfolding and awaits discovery.
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Affiliation(s)
- Aldostefano Porcari
- National Amyloidosis Centre, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK; Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste 34149, Italy; European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy.
| | - Gianfranco Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste 34149, Italy; European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Philip N Hawkins
- National Amyloidosis Centre, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK
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Göbel S, Braun AS, Hahad O, von Henning U, Brandt M, Keller K, Gaida MM, Gori T, Schultheiss HP, Escher F, Münzel T, Wenzel P. Etiologies and predictors of mortality in an all-comer population of patients with non-ischemic heart failure. Clin Res Cardiol 2024; 113:737-749. [PMID: 38224373 PMCID: PMC11026225 DOI: 10.1007/s00392-023-02354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Despite progress in diagnosis and therapy of heart failure (HF), etiology and risk stratification remain elusive in many patients. METHODS The My Biopsy HF Study (German clinical trials register number: DRKS22178) is a retrospective monocentric study investigating an all-comer population of patients with unexplained HF based on a thorough workup including endomyocardial biopsy (EMB). RESULTS 655 patients (70.9% men, median age 55 [45/66] years) with non-ischemic, non-valvular HF were included in the analyses. 489 patients were diagnosed with HF with reduced ejection fraction (HFrEF), 52 patients with HF with mildly reduced ejection fraction (HFmrEF) and 114 patients with HF with preserved ejection fraction (HFpEF). After a median follow-up of 4.6 (2.5/6.6) years, 94 deaths were enumerated (HFrEF: 68; HFmrEF: 8; HFpEF: 18), equating to mortality rates of 3.3% and 11.6% for patients with HFrEF, 7.7% and 15.4% for patients with HFmrEF and 5.3% and 11.4% for patients with HFpEF after 1 and 5 years, respectively. In EMB, we detected a variety of putative etiologies of HF, including incidental cardiac amyloidosis (CA, 5.8%). In multivariate logistic regression analysis adjusting for age, sex and comorbidities only CA, age and NYHA functional class III + IV remained independently associated with all-cause mortality (CA: HRperui 3.13, 95% CI 1.5-6.51; p = 0.002). CONCLUSIONS In an all-comer population of patients presenting with HF of unknown etiology, incidental finding of CA stands out to be independently associated with all-cause mortality. Our findings suggest that prospective trials would be helpful to test the added value of a systematic and holistic work-up of HF of unknown etiology.
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Affiliation(s)
- S Göbel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - A S Braun
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - O Hahad
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - U von Henning
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Brandt
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - K Keller
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - M M Gaida
- Institute of Pathology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Mainz, Germany
- TRON, Translational Oncology at the University Medical Center Mainz, Mainz, Germany
| | - T Gori
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - F Escher
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - T Münzel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - P Wenzel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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Patel KP, Scully PR, Saberwal B, Sinha A, Yap-Sanderson JJL, Cheasty E, Mullen M, Menezes LJ, Moon JC, Pugliese F, Klotz E, Treibel TA. Regional Distribution of Extracellular Volume Quantified by Cardiac CT in Aortic Stenosis: Insights Into Disease Mechanisms and Impact on Outcomes. Circ Cardiovasc Imaging 2024; 17:e015996. [PMID: 38771906 DOI: 10.1161/circimaging.123.015996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/19/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Extracellular volume fraction (ECV) is a marker for myocardial fibrosis and infiltration, can be quantified using cardiac computed tomography (ECVCT), and has prognostic utility in several diseases. This study aims to map out regional differences in ECVCT to obtain greater insights into the pathophysiological mechanisms of ECV expansion and its clinical implications. METHODS Three prospective cohorts were included: patients with aortic stenosis (AS) and coexisting AS and transthyretin cardiac amyloidosis were referred for a transcatheter aortic valve replacement and had ECG-gated CT angiography and Technetium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy to differentiate between the 2 cohorts. Controls had CT angiography and cardiac magnetic resonance demonstrating no significant coronary artery disease or infarction. Global and regional ECVCT was analyzed, and its association with mortality was assessed for patients with AS. RESULTS In 199 patients, controls (n=65; 66% male), AS (n=115), and coexisting AS and transthyretin cardiac amyloidosis (n=19) had a global ECVCT of 26.1 (25.0-27.8%) versus 29.1 (27.5-31.1%) versus 37.4 (32.5-46.6%), respectively; P<0.001. Across cohorts, ECVCT was higher at the base (versus apex), the inferoseptum (versus anterolateral wall), and the subendocardium (versus subepicardium); P<0.05 for all. Among patients with AS, epicardial ECVCT, rather than any other regional value or global ECVCT, was the strongest predictor of mortality at a median of 3.9 (max 6.3) years (adjusted hazard ratio, 1.21 [95% CI, 1.08-1.36]; P=0.002). CONCLUSIONS Regional differences in ECVCT suggest a predilection for fibrosis and amyloid infiltration at the base, subendocardium, inferior wall, and septum more than the anterior and lateral myocardium. ECVCT can predict long-term mortality with the subepicardium demonstrating the strongest discriminatory power. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03029026 and NCT03094143.
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Affiliation(s)
- Kush P Patel
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
- Institute of Cardiovascular Sciences, University College London, United Kingdom (K.P.P., P.R.S., J.C.M., T.A.T.)
| | - Paul R Scully
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
| | - Bunny Saberwal
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
- William Harvey Research Institute, Queen Mary University of London, United Kingdom (B.S., F.P., T.A.T.)
| | - Apurva Sinha
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
| | - Joanna J L Yap-Sanderson
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
| | - Emma Cheasty
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
| | - Michael Mullen
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
| | - Leon J Menezes
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
- Institute of Nuclear Medicine, University College London, United Kingdom (L.J.M.)
- NIHR University College London Hospitals Biomedical Research Centre, United Kingdom (L.J.M.)
| | - James C Moon
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
| | - Francesca Pugliese
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
- William Harvey Research Institute, Queen Mary University of London, United Kingdom (B.S., F.P., T.A.T.)
| | - Ernst Klotz
- Siemens Healthineers, Forchheim, Germany (E.K.)
| | - Thomas A Treibel
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)
- Institute of Cardiovascular Sciences, University College London, United Kingdom (K.P.P., P.R.S., J.C.M., T.A.T.)
- William Harvey Research Institute, Queen Mary University of London, United Kingdom (B.S., F.P., T.A.T.)
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9
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Kato S, Misumi Y, Horita N, Yamamoto K, Utsunomiya D. Clinical Utility of Computed Tomography-Derived Myocardial Extracellular Volume Fraction: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2024; 17:516-528. [PMID: 37999657 DOI: 10.1016/j.jcmg.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 09/06/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Computed tomography (CT)-derived extracellular volume fraction (ECV) is a noninvasive method to quantify myocardial fibrosis. Although studies suggest CT is a suitable measure of ECV, clinical use remains limited. OBJECTIVES A meta-analysis was performed to determine the clinical value of CT-derived ECV in cardiovascular diseases. METHODS Electronic database searches of PubMed, Web of Science Core Collection, Cochrane advanced search, and EMBASE were performed. The most pivotal analysis entailed the comparison of ECV ascertained through CT-ECV among the control, aortic stenosis, and cardiac amyloidosis cohorts. The diagnostic test accuracy for detecting cardiac amyloidosis was assessed using summary receiver-operating characteristics curve. RESULTS Pooled CT-derived ECV values were 28.5% (95% CI: 27.3%-29.7%) in the control, 31.9% (95% CI: 30.2%-33.8%) in the aortic stenosis, and 48.9% (95% CI: 44.5%-53.3%) in the cardiac amyloidosis group. ECV was significantly elevated in aortic stenosis (P = 0.002) (vs controls) but further elevated in cardiac amyloidosis (P < 0.001) (vs aortic stenosis). CT-derived ECV had a high diagnostic accuracy for cardiac amyloidosis, with sensitivity of 92.8% (95% CI: 86.7%-96.2%), specificity of 84.8% (95% CI: 68.6%-93.4%), and area under the summary receiver-operating characteristic curve of 0.94 (95% CI: 0.88-1.00). CONCLUSIONS This study is the first comprehensive systematic review and meta-analysis of CT-derived ECV evaluation in cardiac disease. The high diagnostic accuracy of CT-ECV suggests the usefulness of CT-ECV in the diagnosis of cardiac amyloidosis in preoperative CT planning for transcatheter aortic valve replacement.
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Affiliation(s)
- Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Yuka Misumi
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouji Yamamoto
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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10
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Damluji AA, Nanna MG, Rymer J, Kochar A, Lowenstern A, Baron SJ, Narins CR, Alkhouli M. Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series. JACC Cardiovasc Interv 2024; 17:961-978. [PMID: 38597844 PMCID: PMC11097960 DOI: 10.1016/j.jcin.2024.01.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 04/11/2024]
Abstract
Aging is the gradual decline in physical and physiological functioning leading to increased susceptibility to stressors and chronic illnesses, including cardiovascular disease. With an aging global population, in which 1 in 6 individuals will be older than 60 years by 2030, interventional cardiologists are increasingly involved in providing complex care for older individuals. Although procedural aspects remain their main clinical focus, interventionalists frequently encounter age-associated risks that influence eligibility for invasive care, decision making during the intervention, procedural adverse events, and long-term management decisions. The unprecedented growth in transcatheter interventions, especially for structural heart diseases at extremes of age, have pushed age-related risks and implications for cardiovascular care to the forefront. In this JACC state-of-the-art review, the authors provide a comprehensive overview of the aging process as it relates to cardiovascular interventions, with special emphasis on the difference between chronological and biological aging. The authors also address key considerations to improve health outcomes for older patients during and after their invasive cardiovascular care. The role of "gerotherapeutics" in interventional cardiology, technological innovation in measuring biological aging, and the integration of patient-centered outcomes in the older adult population are also discussed.
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Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research, Fairfax, Virginia, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael G Nanna
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Rymer
- Duke University School of Medicine, Durham, North Carolina USA
| | - Ajar Kochar
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Bart NK, Fatkin D, Gunton J, Hare JL, Korczyk D, Kwok F, Lam K, Russell D, Sidiqi H, Sutton T, Gibbs SDJ, Mollee P, Thomas L. 2024 Australia-New Zealand Expert Consensus Statement on Cardiac Amyloidosis. Heart Lung Circ 2024; 33:420-442. [PMID: 38570258 DOI: 10.1016/j.hlc.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 04/05/2024]
Abstract
Over the past 5 years, early diagnosis of and new treatments for cardiac amyloidosis (CA) have emerged that hold promise for early intervention. These include non-invasive diagnostic tests and disease modifying therapies. Recently, CA has been one of the first types of cardiomyopathy to be treated with gene editing techniques. Although these therapies are not yet widely available to patients in Australia and New Zealand, this may change in the near future. Given the rapid pace with which this field is evolving, it is important to view these advances within the Australian and New Zealand context. This Consensus Statement aims to update the Australian and New Zealand general physician and cardiologist with regards to the diagnosis, investigations, and management of CA.
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Affiliation(s)
- Nicole K Bart
- Department of Cardiology, St Vincent's Hospital, Sydney; School of Clinical Medicine, Faculty of Health and Medicine, The University of New South Wales, Sydney, and The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia. http://www.twitter.com/drnikkibart
| | - Diane Fatkin
- Department of Cardiology, St Vincent's Hospital, Sydney; School of Clinical Medicine, Faculty of Health and Medicine, The University of New South Wales, Sydney, and The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - James Gunton
- Department of Cardiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - James L Hare
- Department of Cardiology, Alfred Health, Melbourne, and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Dariusz Korczyk
- Department of Cardiology, The Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Fiona Kwok
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Kaitlyn Lam
- Department of Cardiology, Western Australia Advanced Heart Failure and Cardiac Transplant Service, Perth, WA, Australia
| | - David Russell
- Department of Cardiology, Royal Hobart Hospital, Hobart, Tas, Australia
| | - Hasib Sidiqi
- Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Tim Sutton
- Te Whatu Ora Counties Manukau, Auckland; and Department of Cardiology, Auckland, Aotearoa, New Zealand
| | - Simon D J Gibbs
- Department of Haematology, Eastern Health; Epworth Freemasons; and Monash University, Melbourne, Vic, Australia
| | - Peter Mollee
- Queensland Amyloidosis Centre, The Princess Alexandra Hospital, Brisbane; and, School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney; Westmead Clinical School, University of Sydney, Sydney; and, South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
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12
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Spielvogel CP, Haberl D, Mascherbauer K, Ning J, Kluge K, Traub-Weidinger T, Davies RH, Pierce I, Patel K, Nakuz T, Göllner A, Amereller D, Starace M, Monaci A, Weber M, Li X, Haug AR, Calabretta R, Ma X, Zhao M, Mascherbauer J, Kammerlander A, Hengstenberg C, Menezes LJ, Sciagra R, Treibel TA, Hacker M, Nitsche C. Diagnosis and prognosis of abnormal cardiac scintigraphy uptake suggestive of cardiac amyloidosis using artificial intelligence: a retrospective, international, multicentre, cross-tracer development and validation study. Lancet Digit Health 2024; 6:e251-e260. [PMID: 38519153 DOI: 10.1016/s2589-7500(23)00265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND The diagnosis of cardiac amyloidosis can be established non-invasively by scintigraphy using bone-avid tracers, but visual assessment is subjective and can lead to misdiagnosis. We aimed to develop and validate an artificial intelligence (AI) system for standardised and reliable screening of cardiac amyloidosis-suggestive uptake and assess its prognostic value, using a multinational database of 99mTc-scintigraphy data across multiple tracers and scanners. METHODS In this retrospective, international, multicentre, cross-tracer development and validation study, 16 241 patients with 19 401 scans were included from nine centres: one hospital in Austria (consecutive recruitment Jan 4, 2010, to Aug 19, 2020), five hospital sites in London, UK (consecutive recruitment Oct 1, 2014, to Sept 29, 2022), two centres in China (selected scans from Jan 1, 2021, to Oct 31, 2022), and one centre in Italy (selected scans from Jan 1, 2011, to May 23, 2023). The dataset included all patients referred to whole-body 99mTc-scintigraphy with an anterior view and all 99mTc-labelled tracers currently used to identify cardiac amyloidosis-suggestive uptake. Exclusion criteria were image acquisition at less than 2 h (99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, 99mTc-hydroxymethylene diphosphonate, and 99mTc-methylene diphosphonate) or less than 1 h (99mTc-pyrophosphate) after tracer injection and if patients' imaging and clinical data could not be linked. Ground truth annotation was derived from centralised core-lab consensus reading of at least three independent experts (CN, TT-W, and JN). An AI system for detection of cardiac amyloidosis-associated high-grade cardiac tracer uptake was developed using data from one centre (Austria) and independently validated in the remaining centres. A multicase, multireader study and a medical algorithmic audit were conducted to assess clinician performance compared with AI and to evaluate and correct failure modes. The system's prognostic value in predicting mortality was tested in the consecutively recruited cohorts using cox proportional hazards models for each cohort individually and for the combined cohorts. FINDINGS The prevalence of cases positive for cardiac amyloidosis-suggestive uptake was 142 (2%) of 9176 patients in the Austrian, 125 (2%) of 6763 patients in the UK, 63 (62%) of 102 patients in the Chinese, and 103 (52%) of 200 patients in the Italian cohorts. In the Austrian cohort, cross-validation performance showed an area under the curve (AUC) of 1·000 (95% CI 1·000-1·000). Independent validation yielded AUCs of 0·997 (0·993-0·999) for the UK, 0·925 (0·871-0·971) for the Chinese, and 1·000 (0·999-1·000) for the Italian cohorts. In the multicase multireader study, five physicians disagreed in 22 (11%) of 200 cases (Fleiss' kappa 0·89), with a mean AUC of 0·946 (95% CI 0·924-0·967), which was inferior to AI (AUC 0·997 [0·991-1·000], p=0·0040). The medical algorithmic audit demonstrated the system's robustness across demographic factors, tracers, scanners, and centres. The AI's predictions were independently prognostic for overall mortality (adjusted hazard ratio 1·44 [95% CI 1·19-1·74], p<0·0001). INTERPRETATION AI-based screening of cardiac amyloidosis-suggestive uptake in patients undergoing scintigraphy was reliable, eliminated inter-rater variability, and portended prognostic value, with potential implications for identification, referral, and management pathways. FUNDING Pfizer.
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Affiliation(s)
- Clemens P Spielvogel
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - David Haberl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Mascherbauer
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Jing Ning
- Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
| | - Kilian Kluge
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Rhodri H Davies
- Institute of Cardiovascular Science, University College London, London, UK; Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Iain Pierce
- Institute of Cardiovascular Science, University College London, London, UK; Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Kush Patel
- Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Thomas Nakuz
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Adelina Göllner
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Amereller
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Starace
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Alice Monaci
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Xiang Li
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander R Haug
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
| | - Raffaella Calabretta
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Xiaowei Ma
- Department of Nuclear Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Min Zhao
- Department of Nuclear Medicine, Third Xiangya Hospital, Central South University, Changsha, China
| | - Julia Mascherbauer
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St Pölten, Krems, Austria
| | - Andreas Kammerlander
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Leon J Menezes
- Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Roberto Sciagra
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, UK; Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Institute of Cardiovascular Science, University College London, London, UK; Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK.
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13
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Mir T, Uddin M, Ulbeh TM, Perveiz E, Lohia P, Sattar Y, Abohashem S, Ullah W, Maganti K, Qureshi WT, Lakis N. Clinical Outcomes of Aortic Stenosis in Amyloidosis: A United States National Cohort Study. Heart Lung Circ 2024; 33:443-449. [PMID: 38036372 DOI: 10.1016/j.hlc.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 07/21/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Literature regarding outcomes associated with surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) among amyloidosis (AM) with aortic stenosis (AS) is limited. OBJECTIVES We aim to study the mortality and in-hospital clinical outcomes among AM with AS associated with SAVR or TAVR. METHODS We performed a retrospective study of all hospitalisation encounters associated with a diagnosis of AM with AS, using the Nationwide Readmissions Database for the years 2012-2019. Primary outcomes were in-hospital mortality, and 30-day readmissions. RESULTS A total of 4,820 index hospitalisations of AS (mean age 78.35±10.11 years; female 37.76%) among AM were reported. Total 464 patients had mechanical intervention, 251 patients (54.1%) TAVR and 213 patients (45.9%) SAVR. A total of 317 patients (6.77%) with AS died; TAVR 4.4%, SAVR 11.9% (p=0.01) and 6.66% died among the subgroup who did not have any mechanical intervention. Higher complication rates were observed among patients who had SAVR than those who had TAVR including acute kidney injury (39.8% vs 22.4%; p=0.01), septic shock (12.1% vs 4.4%; p=0.05) and cardiogenic shock (22% vs 4.4%; p<0.001). Acute heart failure was higher among patients who had TAVR (40.2% vs 27.5%; p=0.04) than those who had SAVR. All conduction block and ischaemic stroke were similar between the two groups (p=0.09 and p=0.1). The overall 30-day readmission rate among AM with AS encounters was 16.82%, higher among TAVR compared to SAVR subgroups (21.25% vs 11.17%; p=0.001). CONCLUSIONS Among AM with AS hospitalisations, TAVR had mortality benefits compared to SAVR and non-mechanical intervention subgroups. Moreover, higher 30-day mortality rate were observed among SAVR subgroup, which may suggest that TAVR should be strongly considered in AM patients complicated by AS.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Wayne State University, Detroit, MI, USA; Internal Medicine, Baptist Health System, Montgomery, AL, USA.
| | - Mohammed Uddin
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | | | - Eskara Perveiz
- Internal Medicine, Baptist Health System, Montgomery, AL, USA
| | - Prateek Lohia
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Yasar Sattar
- Cardiology Division, University of Virginia, Charlottesville, VA, USA
| | - Shady Abohashem
- Cardiology Division, Harvard Medical School Massachusetts General Hospital, Boston, MA, USA
| | - Waqas Ullah
- Cardiology Division, Thomas Jefferson University, PA, USA
| | | | - Waqas T Qureshi
- Cardiology Division, University of Massachusetts, Amherst, MA, USA
| | - Nasser Lakis
- Internal Medicine, Wayne State University, Detroit, MI, USA
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14
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Koike H, Fukui M, Treibel T, Stanberry LI, Cheng VY, Enriquez-Sarano M, Schmidt S, Schelbert EB, Wang C, Okada A, Phichaphop A, Sorajja P, Bapat VN, Leipsic J, Lesser JR, Cavalcante JL. Comprehensive Myocardial Assessment by Computed Tomography: Impact on Short-Term Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2024; 17:396-407. [PMID: 37921717 DOI: 10.1016/j.jcmg.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/12/2023] [Accepted: 08/10/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Quantification of myocardial changes in severe aortic stenosis (AS) is prognostically important. The potential for comprehensive myocardial assessment pre-transcatheter aortic valve replacement (TAVR) by computed tomography angiography (CTA) is unknown. OBJECTIVES This study sought to evaluate whether quantification of left ventricular (LV) extracellular volume-a marker of myocardial fibrosis-and global longitudinal strain-a marker of myocardial deformation-at baseline CTA associate with post-TAVR outcomes. METHODS Consecutive patients with symptomatic severe AS between January 2021 and June 2022 who underwent pre-TAVR CTA were included. Computed tomography extracellular volume (CT-ECV) was derived from septum tracing after generating the 3-dimensional CT-ECV map. Computed tomography global longitudinal strain (CT-GLS) used semi-automated feature tracking analysis. The clinical endpoint was the composite outcome of all-cause mortality and heart failure hospitalization. RESULTS Among the 300 patients (80.0 ± 9.4 years of age, 45% female, median Society of Thoracic Surgeons Predicted Risk of Mortality score 2.80%), the left ventricular ejection fraction (LVEF) was 58% ± 12%, the median CT-ECV was 28.5% (IQR: 26.2%-32.1%), and the median CT-GLS was -20.1% (IQR: -23.8% to -16.3%). Over a median follow-up of 16 months (IQR: 12-22 months), 38 deaths and 70 composite outcomes occurred. Multivariable Cox proportional hazards model, accounting for clinical and echocardiographic variables, demonstrated that CT-ECV (HR: 1.09 [95% CI: 1.02-1.16]; P = 0.008) and CT-GLS (HR: 1.07 [95% CI: 1.01-1.13]; P = 0.017) associated with the composite outcome. In combination, elevated CT-ECV and CT-GLS (above median for each) showed a stronger association with the outcome (HR: 7.14 [95% CI: 2.63-19.36]; P < 0.001). CONCLUSIONS Comprehensive myocardial quantification of CT-ECV and CT-GLS associated with post-TAVR outcomes in a contemporary low-risk cohort with mostly preserved LVEF. Whether these imaging biomarkers can be potentially used for the decision making including timing of AS intervention and post-TAVR follow-up will require integration into future clinical trials.
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Affiliation(s)
- Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Thomas Treibel
- Institute of Cardiovascular Science, University College London, and Barts Heart Centre, St Bartholomew Hospital, London, United Kingdom
| | - Larissa I Stanberry
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Victor Y Cheng
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maurice Enriquez-Sarano
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Stephanie Schmidt
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Erik B Schelbert
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Asa Phichaphop
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Vinayak N Bapat
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Lesser
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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15
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Minga I, Kwak E, Hussain K, Wathen L, Gaznabi S, Singh L, Macrinici V, Wang CH, Singulane C, Addetia K, Sarswat N, Slivnick J, Pursnani A. Prevalence of valvular heart disease in cardiac amyloidosis and impact on survival. Curr Probl Cardiol 2024; 49:102417. [PMID: 38280494 DOI: 10.1016/j.cpcardiol.2024.102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Limited data exists on the prognostic impact of valvular heart disease in cardiac amyloidosis (CA). We therefore sought to define the prevalence of valvular disease in patients with CA and assess the effects of significant valve disease on survival. METHODS This multi-center retrospective cohort study included consecutive patients with confirmed transthyretin (TTR) or light chain (AL) amyloidosis. Echocardiographic data closest to the date of amyloid diagnosis was reviewed, and severity was graded according to ASE guidelines. Kaplan-Meier survival analysis was performed to compare survival between patients with moderate or greater valve disease against those with mild or less disease. RESULTS We included 345 patients (median age 76 years; 73 % men; 110 AL, 235TTR). The median survival for the total patient cohort with cardiac amyloidosis was 2.92 years, with 30 % of patients surviving at five years after their diagnosis. Median survival comparing AL vs ATTR was 2.58 years vs 2.82 years (p = 0.67) The most common valvular abnormalities in the total cohort were mitral (62 %) and tricuspid (66 %).regurgitation There was a statistically significant difference in median survival between patients with no or mild MR compared to those with moderate or severe MR (2.92 years vs 3.35 years, p = 0.0047) (Fig. 5). There was a statistically significant difference in median survival in patients with no or mild TR compared to those with moderate or severe TR (3.35 years vs 2.3 years, p = 0.015). CONCLUSION Our study demonstrates a significant prevalence of mitral and tricuspid regurgitation in CA, with patients with moderate to severe MR and TR having a poorer prognosis.
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Affiliation(s)
- Iva Minga
- University of Chicago Medical Center, Chicago, IL, United States.
| | - Esther Kwak
- Medical College of Milwaukee Medical Center, Milwaukee, IL, United States
| | - Kifah Hussain
- Northshore University HealthSystem, Evanston, IL, United States
| | - Lucas Wathen
- Northshore University HealthSystem, Evanston, IL, United States
| | | | - Lavisha Singh
- Northshore University HealthSystem, Evanston, IL, United States
| | | | - Chi-Hsiung Wang
- Northshore University HealthSystem, Evanston, IL, United States
| | | | - Karima Addetia
- University of Chicago Medical Center, Chicago, IL, United States
| | - Nitasha Sarswat
- University of Chicago Medical Center, Chicago, IL, United States
| | - Jeremy Slivnick
- University of Chicago Medical Center, Chicago, IL, United States
| | - Amit Pursnani
- Northshore University HealthSystem, Evanston, IL, United States
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16
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Gilchrist IC, Kort S, Wang TY, Tannous H, Pyo R, Gracia E, Bilfinger T, Skopicki HA, Parikh PB. Impact of left ventricular ejection fraction and aortic valve gradient on mortality following transcatheter aortic valve intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00089-7. [PMID: 38490937 DOI: 10.1016/j.carrev.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Data regarding the impact of reduced left ventricular ejection fraction (LVEF) and/or reduced mean aortic valve gradient (AVG) on outcomes following transcatheter aortic valve intervention (TAVI) have been conflicting. We sought to assess the relationship between LVEF, AVG, and 1-year mortality in patients undergoing TAVI. METHODS We prospectively evaluated 298 consecutive adults undergoing TAVI from 2015 to 2018 at an academic tertiary medical center. Patients were categorized according to LVEF and mean AVG. The primary outcome of interest was all-cause mortality at 1 year. RESULTS Of 298 adults undergoing TAVI, 66 (22.1%) had baseline LVEF ≤45% while 232 (77.9%) had baseline LVEF >45%; 173 (58.1%) had baseline AVG < 40mmHg while 125 (41.9%) had baseline AVG ≥ 40mmHg. Rates of 1-year all-cause mortality were significantly higher in patients with LVEF ≤45% (28.8% vs 12.1%, p = 0.001) and those with AVG < 40mmHg (19.7% vs 10.4%, p = 0.031) compared to those with LVEF >45% and AVG ≥ 40mmHg respectively. In multivariable analysis, higher AVG (per mmHg) (OR 0.97, 95% CI 0.94-0.99, p = 0.026) was noted to be independently associated with lower rates of 1-year mortality, while LVEF was not (OR 0.98, 95% CI 0.96-1.01). CONCLUSIONS In this prospective, contemporary registry of adults undergoing TAVI, while 1-year unadjusted mortality rates are significantly higher in patients with reduced LVEF and reduced AVG, risk-adjusted mortality at 1 year is only higher in those with reduced AVG - not in those with reduced LVEF.
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Affiliation(s)
- Ian C Gilchrist
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Smadar Kort
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Ting-Yu Wang
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Henry Tannous
- Department of Surgery, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Robert Pyo
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Ely Gracia
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Thomas Bilfinger
- Department of Surgery, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Hal A Skopicki
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Puja B Parikh
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
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17
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Wu D, Chen W. Molecular mechanisms and emerging therapies in wild-type transthyretin amyloid cardiomyopathy. Heart Fail Rev 2024; 29:511-521. [PMID: 38233673 PMCID: PMC10942909 DOI: 10.1007/s10741-023-10380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/19/2024]
Abstract
Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is an underrecognized cause of heart failure due to misfolded wild-type transthyretin (TTRwt) myocardial deposition. The development of wild-type TTR amyloid fibrils is a complex pathological process linked to the deterioration of homeostatic mechanisms owing to aging, plausibly implicating multiple molecular mechanisms. The components of amyloid transthyretin often include serum amyloid P, proteoglycans, and clusterin, which may play essential roles in the localization and elimination of amyloid fibrils. Oxidative stress, impaired mitochondrial function, and perturbation of intracellular calcium dynamics induced by TTR contribute to cardiac impairment. Recently, tafamidis has been the only drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of ATTRwt-CM. In addition, small interfering RNAs and antisense oligonucleotides for ATTR-CM are promising therapeutic approaches and are currently in phase III clinical trials. Newly emerging therapies, such as antibodies targeting amyloid, inhibitors of seed formation, and CRISPR‒Cas9 technology, are currently in the early stages of research. The development of novel therapies is based on progress in comprehending the molecular events behind amyloid cardiomyopathy. There is still a need to further advance innovative treatments, providing patients with access to alternative and effective therapies, especially for patients diagnosed at a late stage.
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Affiliation(s)
- Danni Wu
- Dept. of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wei Chen
- Dept. of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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18
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San Román JA, Ybarra-Falcón C, García-Gómez M, Ramos N, Nombela L, Carnero M, Amat-Santos IJ, Sevilla T, Revilla A, Carrasco M, López-Díaz J, Vilacosta I. Evolution and Prognostic Significance of Patient-Reported Symptoms After Intervention in Severe Aortic Stenosis. Mayo Clin Proc 2024; 99:400-410. [PMID: 38432746 DOI: 10.1016/j.mayocp.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/24/2023] [Accepted: 09/27/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To describe the evolution of symptoms in patients with symptomatic severe aortic stenosis (sSAS) undergoing valve replacement, the predictors of the persistence of these symptoms, and their prognostic significance. The evolution of symptoms after intervention in sSAS and their association with outcome are unknown. PATIENTS AND METHODS Data from patients with sSAS who underwent intervention were collected. All-cause mortality and cardiovascular mortality were considered events. The evolution of symptoms and their association with events were studied. RESULTS In this study, 451 consecutive patients with sSAS and no other valvular or coronary disease who were alive 30 days after intervention were included. Before valve replacement, 133 of the 451 patients (29.5%) had congestive heart failure requiring hospitalization. Of the remaining 318 patients, 287 (90.2%) had dyspnea on effort, 129 (40.6%) had angina, and 59 had syncope (18.6%). Symptoms disappeared after intervention in 192 of the 451 patients (42.6%) and remained in 259 (57.4%): 193 dyspnea, 9 angina, 17 syncope, and 60 admission for heart failure. Syncope on effort persisted in 4 of 33 patients (12.1%) and at rest in 11 of 20 (55.0%; P<.001). Age, body mass index, previous admission for heart failure, and chronic obstructive pulmonary disease were independently related to persistence of symptoms. Over a median follow-up of 56 months in our cohort of 451 patients, 129 deaths were registered (28.6%), 40 of which were cardiovascular (8.9%). Age, chronic obstructive pulmonary disease, chronic kidney disease, atrial fibrillation, heart failure, and persistence of symptoms were independently associated with all-cause mortality. CONCLUSION Symptoms attributed to SAS remain after intervention in a high proportion of patients, particularly dyspnea on effort and syncope at rest. The persistence of symptoms after intervention identifies patients with poor outcome.
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Affiliation(s)
- J Alberto San Román
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | | | - Mario García-Gómez
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Noemí Ramos
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Nombela
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Teresa Sevilla
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Revilla
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Manuel Carrasco
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier López-Díaz
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
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19
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Sabbour H, Al-Humood K, Al Taha Z, Romany I, Haddadin H, Mohty D. A wolf in sheep's clothing-aortic stenosis and cardiac amyloidosis: "RAISE"ing awareness in clinical practice. Front Cardiovasc Med 2024; 11:1323023. [PMID: 38464842 PMCID: PMC10921426 DOI: 10.3389/fcvm.2024.1323023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/15/2024] [Indexed: 03/12/2024] Open
Abstract
Aesop's fable of the wolf in sheep's clothing encourages us to look beneath the exterior appearance of a situation and evaluate the truth that lies beneath. This concept should be applied when managing older patients with severe aortic stenosis. This population of patients is increasingly being identified as having concomitant cardiac amyloidosis, which is an underrecognized cause of common cardiac conditions. The presence of cardiac amyloidosis negatively affects the outcome of patients with aortic stenosis, these patients undergo transcatheter aortic valve replacement (TAVR) with increasing frequency and have a significantly higher overall mortality rate than patients with aortic stenosis alone. Although left ventricular wall hypertrophy is expected in patients with aortic stenosis, it should not be assumed that this is caused only by aortic stenosis. A suspicion of cardiac amyloidosis should be raised in patients in whom the degree of hypertrophy is disproportionate to the degree of aortic stenosis severity. The remodeling, age, injury, systemic, and electrical (RAISE) score was developed to predict the presence of cardiac amyloidosis in patients with severe aortic stenosis. This article highlights the value of increased clinical suspicion, demonstrates the use of the multiparameter RAISE score in daily clinical practice, and illustrates the scoring system with case studies. In elderly patients being considered for TAVR, systematic testing for cardiac amyloidosis should be considered as part of the preoperative workup.
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Affiliation(s)
- H. Sabbour
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Warren Alpert School of Medicine, Brown University, Providence, RI, United States
| | - K. Al-Humood
- Advanced Heart Failure and Transplantation Unit, Chest Disease Hospital, Kuwait City, Kuwait
| | - Z. Al Taha
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - I. Romany
- Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | - H. Haddadin
- Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | - D. Mohty
- Heart Center, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
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20
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Hauptmann L, Nitsche C. All roads lead to… myocardial ischaemia in cardiac amyloidosis. Eur J Heart Fail 2024. [PMID: 38369886 DOI: 10.1002/ejhf.3175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024] Open
Affiliation(s)
- Laurenz Hauptmann
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
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21
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Sugiyama Y, Miyashita H, Yokoyama H, Ochiai T, Shishido K, Jalanko M, Yamanaka F, Vähäsilta T, Saito S, Laine M, Moriyama N. Risk Assessment of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation in Patients With Preexisting Right Bundle Branch Block. Am J Cardiol 2024; 213:151-160. [PMID: 38103766 DOI: 10.1016/j.amjcard.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/16/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
Preexisting right bundle branch block (RBBB) is the strongest predictor for permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI). However, the risk assessment for new PPI and effective procedural strategy for preventing new PPI in patients with preexisting RBBB are still unclear. This study stratified the new PPI risk after TAVI and investigated the impact of implantation strategy in a preexisting RBBB cohort. We analyzed 237 patients with preexisting RBBB who underwent TAVI. The primary endpoint was the incidence of new PPI. Multivariate analyses investigating predictors for new PPI were performed. The overall PPI rate was 33.3%. Significant baseline predictors for new PPI were combination of RBBB, left anterior or posterior fascicular block, and first-degree atrioventricular block (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.09 to 5.04), high calcium volume of noncoronary cusp (OR 2.08, 95% CI 1.05 to 4.10), and membranous septum (MS) length <2 mm (OR 2.02, 95% CI 1.09 to 3.75) in the univariate analysis and MS length <2 mm (OR 2.25, 95% CI 1.06 to 4.82) in the multivariate analysis. On the multivariate analysis including procedural variables, predilatation (OR 2.41, 95% CI 1.01 to 5.83), self-expanding valves (Corevalve, Evolut R, and Evolut Pro/Pro+; Medtronic Inc., Minneapolis, Minnesota) or mechanical expanding valves (Lotus/Lotus Edge; Boston Scientifics, Marlborough, Massachusetts) (OR 3.00, 95% CI 1.31 to 6.91), and implantation depth > MS length (OR 4.27, 95% CI 1.81 to 10.08) were significantly associated with new PPI. The incidence of new PPI increased according to the number of baseline predictors (0: 20.9%, 1: 34.3%, and ≥2: 52.0%) and procedural predictors (0: 3.7%, 1: 20.9%, 2: 40.5%, and 3: 60.0%). New PPI risk in a preexisting RBBB subset could be stratified by baseline factors. Device selection and implantation strategy considering MS length could prevent new PPI even in these high-risk population.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan; Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Hirokazu Miyashita
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan.
| | - Hiroaki Yokoyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Tomoki Ochiai
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Mikko Jalanko
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Tommi Vähäsilta
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan
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22
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Parikh PB, Mack M, Stone GW, Anker SD, Gilchrist IC, Kalogeropoulos AP, Packer M, Skopicki HA, Butler J. Transcatheter aortic valve replacement in heart failure. Eur J Heart Fail 2024; 26:460-470. [PMID: 38297972 DOI: 10.1002/ejhf.3151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
Patients with severe aortic stenosis (AS) may develop heart failure (HF), the presence of which has traditionally been deemed as a final stage in AS progression with poor outcomes. The use of transcatheter aortic valve replacement (TAVR) has become the preferred therapy for most patients with AS and concomitant HF. With its instant afterload reduction, TAVR offers patients with HF significant haemodynamic benefits, with corresponding changes in left ventricular structure and improved mortality and quality of life. The prognostic covariates and optimal timing of TAVR in patients with less than severe AS remain unclear. The purpose of this review is to describe the association between TAVR and outcomes in patients with HF, particularly in the setting of left ventricular systolic dysfunction, acute HF, and right ventricular systolic dysfunction, and to highlight areas for future research.
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Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Michael Mack
- Department of Cardiac Surgery, Baylor Scott & White Health, Plano, TX, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ian C Gilchrist
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | | | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Hal A Skopicki
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Javed Butler
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
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23
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Gallone G, Bongiovanni C, Bruno F, Landra F, Andreis A, Fava A, Scudeler L, DE Filippo O, Califaretti E, Cioffi M, Pidello S, Vairo A, Raineri C, Frea S, Giorgi M, Alunni G, Casoni R, Salizzoni S, Conrotto F, D'Ascenzo F, Rinaldi M, DE Ferrari GM. Transthyretin cardiac amyloidosis in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: experience of a single center. Minerva Cardiol Angiol 2024; 72:87-94. [PMID: 37405712 DOI: 10.23736/s2724-5683.23.06175-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Even if prevalent among patients with severe aortic stenosis (AS), the clinical suspicion for transthyretin cardiac amyloidosis (ATTR-CA) remains difficult in this subset. We report our single center experience on ATTR-CA detection among TAVR candidates to provide insights on the prevalence and clinical features of dual pathology as compared to lone AS. METHODS Consecutive severe AS patients undergoing transcatheter aortic valve replacement (TAVR) evaluation at a single center were prospectively included. Those with suspected ATTR-CA based on clinical assessment underwent 99m Tc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) bone scintigraphy. The RAISE score, a novel screening tool with high sensitivity for ATTR-CA in AS, was retrospectively calculated to rule-out ATTR-CA in the remaining patients. Patients were categorized as follow: "ATTR-CA+": patients with confirmed ATTR-CA at DPD bone scintigraphy; "ATTR-CA-": patients with negative DPD bone scintigraphy or a negative RAISE score; "ATTR-CA indeterminate": patients not undergoing ATTR-CA assessment with a positive RAISE score. The characteristics of ATTR-CA+ and ATTR-CA- patients were compared. RESULTS Of 107 included patients, ATTR-CA suspicion was posed in 13 patients and confirmed in six. Patients were categorized as follow: 6 (5.6%) ATTR-CA+, 79 (73.8%) ATTR-CA-, 22 (20.6%) ATTR-CA indeterminate. Excluding ATTR-CA indeterminate patients, the prevalence of ATTR-CA was 7.1% (95% CI 2.6-14.7%). As compared to ATTR-CA - patients, ATTR-CA + patients were older, had higher procedural risk and more extensive myocardial and renal damage. They had higher left ventricle mass index and lower ECG voltages, translating into a lower voltage to mass ratio. Moreover, we describe for the first time bifascicular block as an ECG feature highly specific of patients with dual pathology (50.0% vs. 2.7%, P<0.001). Of note, pericardial effusion was rarely found in patients with lone AS (16.7% vs. 1.2%, P=0.027). No difference in procedural outcomes was observed between groups. CONCLUSIONS Among severe AS patients, ATTR-CA is prevalent and presents with phenotypic features that may aid to differentiate it from lone AS. A clinical approach based on routine search of amyloidosis features might lead to selective DPD bone scintigraphy with a satisfactory positive predictive value.
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Affiliation(s)
- Guglielmo Gallone
- Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | | | - Francesco Bruno
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Landra
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Antonella Fava
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luca Scudeler
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ovidio DE Filippo
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Elena Califaretti
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Martina Cioffi
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Pidello
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandro Vairo
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Claudia Raineri
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Simone Frea
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mauro Giorgi
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Gianluca Alunni
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Roberta Casoni
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Salizzoni
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Conrotto
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Mauro Rinaldi
- Città della Salute e della Scienza, University of Turin, Turin, Italy
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24
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Jakstaite AM, Vogel JK, Luedike P, Jánosi RA, Carpinteiro A, Rischpler C, Herrmann K, Rassaf T, Papathanasiou M. Screening for Occult Transthyretin Amyloidosis in Patients with Severe Aortic Stenosis and Amyloid Red Flags. J Clin Med 2024; 13:671. [PMID: 38337363 PMCID: PMC10856049 DOI: 10.3390/jcm13030671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
AIMS The optimal strategy to identify transthyretin-type cardiac amyloidosis (ATTR-CA) in patients with aortic stenosis (AS) is still unclear. This study aimed to investigate if targeted screening for ATTR-CA in patients with severe AS and amyloid red flags is associated with higher detection rates. METHODS The study prospectively enrolled patients ≥65 years with severe AS. Patients who fulfilled ≥1 major (carpal tunnel syndrome (CTS), ruptured biceps tendon, spinal stenosis, N-terminal pro B-type natriuretic peptide ≥1000 pg/mL, cardiac troponin >99th percentile) or ≥2 minor criteria (diastolic dysfunction ≥2 grade/lateral e' <10 cm/s, atrial fibrillation, atrioventricular conduction disease/pacemaker) received bone scintigraphy and biochemical analysis for light chain amyloidosis. Hypertensive patients (>140/90 mmHg) and those with interventricular septal thickness (IVSd) ≤13 mm were excluded. RESULTS Overall, 264 patients were screened, of whom 85 were included in the analysis. Tracer uptake Perugini grade ≥1 was detected in nine patients (11%). An endomyocardial biopsy was additionally performed in four of nine patients, yielding a prevalence of 7% (n = 6). All patients with dual AS-ATTR were male. Syncope was more commonly reported in AS-ATTR patients (50% vs. 6%, p = 0.010), who also tended to have more severe hypertrophy (IVSd of 18 vs. 16 mm, p = 0.075). Pericardial effusion and CTS were more common in patients with dual pathology (67% vs. 8%, p < 0.001, and 83% vs. 24%, p = 0.003, respectively). CONCLUSION Targeted screening for ATTR-CA in patients with AS and amyloid red flags does not yield higher detection rates than those reported previously in all comers with AS.
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Affiliation(s)
- Aiste Monika Jakstaite
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Julia Kirsten Vogel
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Alexander Carpinteiro
- Department of Hematology and Stem Cell Transplantation, West German Tumor Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174 Stuttgart, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
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25
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Aimo A, Camerini L, Fabiani I, Morfino P, Panichella G, Barison A, Pucci A, Castiglione V, Vergaro G, Sinagra G, Emdin M. Valvular heart disease in patients with cardiac amyloidosis. Heart Fail Rev 2024; 29:65-77. [PMID: 37735319 PMCID: PMC10904406 DOI: 10.1007/s10741-023-10350-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
Cardiac amyloidosis (CA) is an underdiagnosed condition caused by the deposition of misfolded proteins, namely immunoglobulin light chains and transthyretin, in the extracellular spaces of the heart. Any cardiovascular structure can be affected by amyloid infiltration, including the valves. Amyloid accumulation within the cardiac valves may lead to their structural and functional impairment, with a profound impact on patients' prognosis and quality of life. The most common forms of valvular disease in CA are aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR). CA and AS share similar risk factors, disease mechanisms, and remodeling patterns, which make their diagnosis particularly challenging. Patients with both CA and AS experience worse outcomes than CA or AS alone, and transcatheter aortic valve replacement may represent a useful therapeutic strategy in this population. Data on MR and TR are quite limited and mainly coming from case reports or small series. This review paper will summarize our current understanding on the epidemiology, disease mechanisms, echocardiographic features, clinical implications, and therapeutic options of AS, MR, and TR in patients with CA.
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Affiliation(s)
- Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy.
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | - Lara Camerini
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Paolo Morfino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Giorgia Panichella
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Andrea Barison
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Angela Pucci
- Histopathology Department, University Hospital of Pisa, Pisa, Italy
| | - Vincenzo Castiglione
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Michele Emdin
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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26
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Ismayl M, Abbasi M, Al-Abcha A, El-Am E, Alkhouli M, Guerrero M, Dispenzieri A, Nkomo VT, Abou Ezzeddine OF, Grogan M, Anavekar NS. Outcomes of transcatheter aortic valve replacement in patients with and without amyloidosis: A nationwide analysis from the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:34-42. [PMID: 37468384 DOI: 10.1016/j.carrev.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Amyloidosis is a common comorbidity in elderly patients with aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR). This study aims to assess the impact of amyloidosis on the clinical outcomes of TAVR. METHODS This is a retrospective study of the National Inpatient Sample database that identified adult patients (≥18 years) with AS hospitalized for TAVR from 2016 through 2020 to compare outcomes in those with versus without amyloidosis. Our primary outcome was in-hospital mortality. Secondary outcomes included procedural complications, hospital length of stay (LOS), and total costs. TAVR trends in both cohorts were also evaluated. RESULTS The total cohort included 304,710 patients with AS undergoing TAVR, of whom 410 had amyloidosis. Over the study period, TAVR trends increased significantly in patients with and without amyloidosis (both ptrend < 0.01). Patients with amyloidosis were more likely to be older males with atrial fibrillation/flutter, congestive heart failure, renal disease, and dementia compared to non-amyloidosis patients. After adjustment for baseline characteristics, patients with amyloidosis had similar odds of in-hospital mortality (adjusted odds ratio [aOR] 1.66, 95 % confidence interval [CI] 0.34-3.63), heart block (aOR 1.33, 95 % CI 0.84-2.10), permanent pacemaker insertion (aOR 0.67, 95 % CI 0.27-1.66), stroke (aOR 0.90, 95 % CI 0.32-3.13), acute kidney injury, major bleeding, blood transfusion, vascular complications, in addition to similar LOS (p = 0.21) and total costs (p = 0.18) compared to patients without amyloidosis. CONCLUSION In patients with AS undergoing TAVR, comorbid amyloidosis is associated with similar in-hospital mortality and procedural complications compared to patients without amyloidosis.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA.
| | - Muhannad Abbasi
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Angela Dispenzieri
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Omar F Abou Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Martha Grogan
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
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27
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Decotto S, Corna G, Villanueva E, Arenaza DPD, Seropian I, Falconi M, Oberti P, Aguirre MA, Posadas-Martínez ML, Carretero M, Agatiello CR, Pizarro R. Prevalence of moderate-severe aortic stenosis in patients with cardiac amyloidosis in a referral center. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:71-78. [PMID: 38507302 PMCID: PMC11160519 DOI: 10.24875/acm.22000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Aortic stenosis (AS) is currently the most common valvular disease, with an estimated prevalence of over 4% in octogenarians. OBJECTIVE To describe the prevalence of moderate-severe aortic stenosis (AS) in patients with wild type transthyretin amyloidosis (ATTRwt). Also, describe the clinical features, echocardiographic characteristics and clinical evolution. METHOD Retrospective cohort of patients with diagnosis of ATTRwt, belonging to Hospital Italiano de Buenos Aires Institutional Amyloidosis Registry, from 30/11/2007 to 31/05/2021. Patients follow up was carried out through the institution clinical history. The prevalence of moderate-severe AE was estimated and presented as a percentage with its 95% confidence interval (95% CI). The characteristics were compared by groups according to whether or not they had moderate-severe AS. RESULTS 104 patients with ATTRwt were included. Median follow up was 476 days [interquartile range: 192-749]. Moderate-severe AS prevalence at the ATTRwt time of diagnosis was 10.5% (n = 11; 95% CI: 5-18%). The median age of patients with AS moderate-severe at the time of diagnosis of ATTRwt was 86 years [78-91] and the male sex predominated (82%). Most of the patients had a history of heart failure (n = 8) and atrial fibrillation (n = 8) prior to the diagnosis of ATTRwt. Most of the patients were subclassified as low flow low gradient severe AS group (n = 7). Four patients underwent some intervention on the aortic valve. During follow-up, 5 patients (46%) were hospitalized for decompensated heart failure and 4 (36%) died. CONCLUSIONS In our cohort, the coexistence of both pathologies had a similar prevalence as reported in the international literature. It was an elderly population with a high percentage of atrial fibrillation and history of heart failure. Most of the patients presented with severe AS with low flow low gradient.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ma. Lourdes Posadas-Martínez
- Instituto de Medicina Traslacional e Ingeniería Biomédica. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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28
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Gaznabi S, Miranda J, Lorenzatti D, Piña P, Balasubramanian SS, Desai D, Desai A, Ho EC, Scotti A, Gongora CA, Schenone AL, Garcia MJ, Latib A, Parwani P, Slipczuk L. Multimodality Imaging in Aortic Stenosis: Beyond the Valve - Focusing on the Myocardium. Interv Cardiol Clin 2024; 13:101-114. [PMID: 37980060 DOI: 10.1016/j.iccl.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Current guidelines of aortic stenosis (AS) management focus on valve parameters, LV systolic dysfunction, and symptoms; however, emerging data suggest that there may be benefit of aortic valve replacement before it becomes severe by present criteria. Myocardial assessment using novel multimodality imaging techniques exhibits subclinical myocardial injury and remodeling at various stages before guideline-directed interventions, which predicts adverse outcomes. This raises the question of whether implementing serial myocardial assessment should become part of the standard appraisal, thereby identifying high-risk patients aiming to minimize adverse outcomes.
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Affiliation(s)
- Safwan Gaznabi
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, University of Chicago at Northshore University Health System, 1000 Central Street, Evanston, IL 60201, USA
| | - Jeirym Miranda
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, Mount Sinai Morningside. 419 West 114th Street, NY 10025, USA
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, CEDIMAT. Arturo Logroño, Plaza de la Salud, Dr. Juan Manuel Taveras Rodríguez, C. Pepillo Salcedo esq. Santo Domingo, Dominican Republic
| | - Senthil S Balasubramanian
- Division of Cardiology, University of Chicago at Northshore University Health System, 1000 Central Street, Evanston, IL 60201, USA
| | - Darshi Desai
- Department of Internal Medicine, University of California Riverside School of Medicine. 900 University Avenue, Riverside, CA 92521, USA
| | - Aditya Desai
- Department of Internal Medicine, University of California Riverside School of Medicine. 900 University Avenue, Riverside, CA 92521, USA
| | - Edwin C Ho
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Carlos A Gongora
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, 11234 Anderson Street, Loma Linda, CA 92354, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA.
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29
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Ajmone Marsan N, Graziani F, Meucci MC, Wu HW, Lillo R, Bax JJ, Burzotta F, Massetti M, Jukema JW, Crea F. Valvular heart disease and cardiomyopathy: reappraisal of their interplay. Nat Rev Cardiol 2024; 21:37-50. [PMID: 37563454 DOI: 10.1038/s41569-023-00911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Abstract
Cardiomyopathies and valvular heart diseases are typically considered distinct diagnostic categories with dedicated guidelines for their management. However, the interplay between these conditions is increasingly being recognized and they frequently coexist, as in the paradigmatic examples of dilated cardiomyopathy and hypertrophic cardiomyopathy, which are often complicated by the occurrence of mitral regurgitation. Moreover, cardiomyopathies and valvular heart diseases can have a shared aetiology because several genetic or acquired diseases can affect both the cardiac valves and the myocardium. In addition, the association between cardiomyopathies and valvular heart diseases has important prognostic and therapeutic implications. Therefore, a better understanding of their shared pathophysiological mechanisms, as well as of the prevalence and predisposing factors to their association, might lead to a different approach in the risk stratification and management of these diseases. In this Review, we discuss the different scenarios in which valvular heart diseases and cardiomyopathies coexist, highlighting the need for an improved classification and clustering of these diseases with potential repercussions in the clinical management and, particularly, personalized therapeutic approaches.
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Affiliation(s)
- Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Francesca Graziani
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Hoi W Wu
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosa Lillo
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Francesco Burzotta
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Filippo Crea
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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30
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Moscoso J, Rojas P, Baltodano R, Cachicatari A, Quiroz J, Velarde K, Levano G, Pimentel C. Simultaneous onset of acute myocardial infarction, bicuspid aortic stenosis, and cardiac transthyretin amyloidosis-A clinically complex confluence. Echocardiography 2024; 41:e15733. [PMID: 38284668 DOI: 10.1111/echo.15733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/30/2024] Open
Abstract
The coexistence of bicuspid aortic valve disease and coronary artery disease is well-established, but the identification of cardiac amyloidosis in this population has surged with advancing imaging techniques, introducing complexities in patient management. This case report emphasizes the pivotal role of multimodality imaging in accurately diagnosing three concurrent pathologies.
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Affiliation(s)
- Josh Moscoso
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
| | - Paol Rojas
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
| | | | | | - Jose Quiroz
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
| | - Kevin Velarde
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
| | - Gerald Levano
- Department of Cardiology, Guillermo Almenara Hospital, Lima, Perú
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31
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Duca F, Kronberger C, Willixhofer R, Bartko PE, Bergler-Klein J, Nitsche C. Cardiac Amyloidosis and Valvular Heart Disease. J Clin Med 2023; 13:221. [PMID: 38202228 PMCID: PMC10779781 DOI: 10.3390/jcm13010221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Growing interest has accrued in the co-existence of cardiac amyloidosis and valvular heart disease. Amyloid infiltration from either transthyretin (ATTR) or of light chain (AL) origin may affect any structure of the heart, including the valves. The recent literature has mainly focused on aortic stenosis and cardiac amyloidosis, improving our understanding of the epidemiology, diagnosis, treatment and prognosis of this dual pathology. Despite being of high clinical relevance, data on mitral/tricuspid regurgitation and cardiac amyloidosis are rather scarce and mostly limited to case reports and small cases series. It is the aim of this review article to summarize the current evidence of concomitant valvular heart disease and cardiac amyloidosis by including studies on epidemiology, diagnostic approaches, screening possibilities, therapeutic management, and prognostic implications.
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Affiliation(s)
| | | | | | | | | | - Christian Nitsche
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (C.K.); (R.W.); (P.E.B.); (J.B.-K.)
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Larrañaga-Moreira JM, Rodriguez-Serrano AI, Domínguez F, Lalario A, Zorio E, Barriales-Villa R. Impact of SARS-CoV-2 infection in patients with cardiac amyloidosis: Results of a multicentre registry. Med Clin (Barc) 2023; 161:476-482. [PMID: 37684159 DOI: 10.1016/j.medcli.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Descriptions on impact of SARS-CoV-2 infection in patients with cardiac amyloidosis (CA) are lacking. Our aim was to describe the prognosis of those patients. METHODS Retrospective observational study of unvaccinated patients with CA who developed SARS-CoV-2 infection enrolled in eleven centres (March 2020 to May 2021). Descriptive analysis of basal characteristics, hospitalization, mortality, and severe clinical course was performed. Comparisons to a population-based control group were made. RESULTS Forty-one patients were identified. Most patients had wild-type transthyretin CA (61%) and were on NYHA Class II-III (80.5%). CA patients were commonly hospitalized (73.2%) and those were more symptomatic than outpatients (p=0.035). The 24.4% of CA patients died as consequence of SARS-CoV-2 infection. Patients with CA had an increased risk of hospitalization [OR 6.23 (3.05-12.74), p<0.001] and mortality [OR 2.18 (1.01-4.68), p=0.047] when compared to control population after adjustment by age and sex. After a medium follow-time of 311 days, 41.5% of the CA cohort died. CONCLUSIONS SARS-CoV-2 infection is associated with high mortality and hospitalization rates in patients with CA, which exceed that expected by their sex and advanced age.
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Affiliation(s)
- José M Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña (UDC), A Coruña, Spain.
| | - Ana I Rodriguez-Serrano
- Hospital Universitario Virgen de Arrixaca, Murcia. Spain; European Reference Networks for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Fernando Domínguez
- European Reference Networks for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands; Unidad Cardiopatias Familiares, Hospital Universitario Puerta Hierro Majadahonda, IDIPHISA, Madrid, Spain; Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Andrea Lalario
- Cardiovascular Department 'Ospedali Riuniti' and University of Trieste, Trieste, Italy
| | - Esther Zorio
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Madrid, Spain; Unidad Cardiopatías Familiares, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña (UDC), A Coruña, Spain; Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Madrid, Spain
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Arana-Achaga X, Goena-Vives C, Villanueva-Benito I, Solla-Ruiz I, Rengel Jimenez A, Gaspar TI, Urreta-Barallobre I, Barge-Caballero G, Seijas-Marcos S, Cabrera E, Garcia-Pavía P, Basurte Elorz MT, Ayestarán NM, Sierra LT, Robledo Iñarritu M, Lozano-Bahamonde A, Escolar-Perez V, Gómez-Ramírez C, Alzola E, Andrés RN, Francisco Matias JL, Limeres Freire J, Armengou Arxe A, Negre Busó M, Piqueras-Flores J, Martínez-Del Río J, Onaindia Gandarias JJ, Rodriguez Sanchez I, Querejeta Iraola R. Development and Validation of a Prediction Model and Score for Transthyretin Cardiac Amyloidosis Diagnosis: T-Amylo. JACC Cardiovasc Imaging 2023; 16:1567-1580. [PMID: 37389511 DOI: 10.1016/j.jcmg.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Although transthyretin cardiac amyloidosis (ATTR-CA) is often underdiagnosed, clinical suspicion is essential for early diagnosis. OBJECTIVES The aim of this study was to develop and validate a feasible prediction model and score to facilitate the diagnosis of ATTR-CA. METHODS This retrospective multicenter study enrolled consecutive patients who underwent 99mTc-DPD scintigraphy for suspected ATTR-CA. ATTR-CA was diagnosed if Grade 2 or 3 cardiac uptake was evidenced on 99mTc-DPD scintigraphy in the absence of a detectable monoclonal component or by demonstration of amyloid by biopsy. A prediction model for ATTR-CA diagnosis was developed in a derivation sample of 227 patients from 2 centers using multivariable logistic regression with clinical, electrocardiography, analytical, and transthoracic echocardiography variables. A simplified score was also created. Both of them were validated in an external cohort (n = 895) from 11 centers. RESULTS The obtained prediction model combined age, gender, carpal tunnel syndrome, interventricular septum in diastole thickness, and low QRS interval voltages, with an area under the curve (AUC) of 0.92. The score had an AUC of 0.86. Both the T-Amylo prediction model and the score showed a good performance in the validation sample (ie, AUC: 0.84 and 0.82, respectively). They were tested in 3 clinical scenarios of the validation cohort: 1) hypertensive cardiomyopathy (n = 327); 2) severe aortic stenosis (n = 105); and 3) heart failure with preserved ejection fraction (n = 604), all with good diagnostic accuracy. CONCLUSIONS The T-Amylo is a simple prediction model that improves the prediction of ATTR-CA diagnosis in patients with suspected ATTR-CA.
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Affiliation(s)
- Xabier Arana-Achaga
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Donostia University Hospital, Donostia, Spain; Biodonostia Health Research Institute, Donostia, Spain.
| | - Cristina Goena-Vives
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Donostia University Hospital, Donostia, Spain; Biodonostia Health Research Institute, Donostia, Spain; Department of Cardiology, Mendaro Hospital, Mendaro, Spain.
| | - Iñaki Villanueva-Benito
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Donostia University Hospital, Donostia, Spain; Biodonostia Health Research Institute, Donostia, Spain
| | - Itziar Solla-Ruiz
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Donostia University Hospital, Donostia, Spain; Biodonostia Health Research Institute, Donostia, Spain
| | - Ainhoa Rengel Jimenez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Donostia University Hospital, Donostia, Spain; Biodonostia Health Research Institute, Donostia, Spain
| | | | - Iratxe Urreta-Barallobre
- Biodonostia Health Research Institute, Donostia, Spain; Clinical Epidemiology Unit, Donostia University Hospital, Donostia, Spain
| | - Gonzalo Barge-Caballero
- Heart Failure and Cardiac Transplant Unit, Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Seijas-Marcos
- Heart Failure and Cardiac Transplant Unit, Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Spain
| | - Eva Cabrera
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Puerta de Hierro University Hospital, IDIPHISA, CIBERCV, Madrid, Spain
| | - Pablo Garcia-Pavía
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Puerta de Hierro University Hospital, IDIPHISA, CIBERCV, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - María Teresa Basurte Elorz
- Department of Cardiology, Navarra University Hospital, Spain; IdiSNA-Health Research Institute of Navarra, Spain
| | | | | | | | | | - Vanesa Escolar-Perez
- Heart Failure Unit, Department of Cardiology, Basurto University Hospital, Bilbao, Spain
| | | | - Elisabete Alzola
- Department of Cardiology, Cruces-Barakaldo University Hospital, Bizkaia, Spain
| | | | | | - Javier Limeres Freire
- Inherited Cardiac Diseases and Cardiovascular Genetic Unit, Department of Cardiology, Vall de Hebron University Hospital, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium
| | - Arola Armengou Arxe
- Department of Internal Medicine, Dr Josep Trueta University Hospital, Girona, Spain
| | | | - Jesus Piqueras-Flores
- Inherited Cardiac Diseases Unit, Department of Cardiology, Ciudad Real University General Hospital, Ciudad Real, Spain; Facultad de Medicina, University of Castilla la Mancha, Spain
| | - Jorge Martínez-Del Río
- Inherited Cardiac Diseases Unit, Department of Cardiology, Ciudad Real University General Hospital, Ciudad Real, Spain
| | | | | | - Ramón Querejeta Iraola
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Donostia University Hospital, Donostia, Spain; Clinical Epidemiology Unit, Donostia University Hospital, Donostia, Spain
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Herzog E, Leibowitz D, Gatt ME, Koren T, Pollak A. Pathway for the Diagnosis and Management of Cardiac Amyloidosis. Crit Pathw Cardiol 2023; 22:114-119. [PMID: 37625191 DOI: 10.1097/hpc.0000000000000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
The systemic amyloidoses are a broad spectrum of diseases that result from misfolding of proteins that aggregate into amyloid fibrils. In cardiac amyloidosis, amyloid fibrils accumulate in the interstitial space between cardiac myocytes causing cellular injury and impairing compliance. Current data suggest that cardiac amyloidosis is more common than previously thought. Advances in cardiac imaging, diagnostic strategies, and therapies have improved the recognition and treatment of cardiac amyloidosis. A position statement for the diagnosis and treatment of cardiac amyloidosis has been published in 2021 by the European Society of Cardiology and an expert consensus decision pathway was published in 2023 by the American College of Cardiology. These are excellent documents but quite lengthy and complex. For this reason, our team developed a novel and simple pathway to help health care providers diagnose and treat patients with cardiac amyloidosis. Our pathway starts with a section titled "suspicion" in which we provide simple clues or "red flags" that are associated with the cardiac amyloidosis phenotype. It is followed by a section titled "diagnosis," where we present in a simplified 2 × 2 format the laboratory and imaging tests that must be performed for an accurate diagnosis. In the section titled "treatment," we describe the 4 pillars in the management of patients with cardiac amyloidosis, which includes the following: heart failure treatments, management of arrhythmias, treatment of significant aortic stenosis, and appropriate selection of disease modifying therapies. Our algorithm ends with our simplified recommendation for follow-up.
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Affiliation(s)
- Eyal Herzog
- From the Department of Cardiology, Hadassah Medical Center, Hebrew University of Jerusalem, Israel
| | - David Leibowitz
- From the Department of Cardiology, Hadassah Medical Center, Hebrew University of Jerusalem, Israel
| | - Moshe E Gatt
- Department of Hematology, Hadassah Medical Center, Hebrew University of Jerusalem, Israel
| | - Tali Koren
- From the Department of Cardiology, Hadassah Medical Center, Hebrew University of Jerusalem, Israel
| | - Arthur Pollak
- From the Department of Cardiology, Hadassah Medical Center, Hebrew University of Jerusalem, Israel
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Tavakoli S, Onder O. Four-dimensional Cardiac CT Depicts Coexistent Amyloidosis in Older Adults with Severe Aortic Stenosis. Radiology 2023; 309:e233091. [PMID: 38085085 PMCID: PMC10746845 DOI: 10.1148/radiol.233091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Sina Tavakoli
- From the Departments of Radiology (S.T., O.O.) and Medicine (S.T.), University of Pittsburgh, Pittsburgh, Pa; Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa (S.T.); and Department of Radiology, UPMC Presbyterian Hospital, 200 Lothrop St, Suite E200, Pittsburgh, PA 15213 (S.T.)
| | - Omer Onder
- From the Departments of Radiology (S.T., O.O.) and Medicine (S.T.), University of Pittsburgh, Pittsburgh, Pa; Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa (S.T.); and Department of Radiology, UPMC Presbyterian Hospital, 200 Lothrop St, Suite E200, Pittsburgh, PA 15213 (S.T.)
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Bernhard B, Leib Z, Dobner S, Demirel C, Caobelli F, Rominger A, Schütze J, Grogg H, Alwan L, Spano G, Boscolo Berto M, Lanz J, Pilgrim T, Windecker S, Stortecky S, Gräni C. Routine 4D Cardiac CT to Identify Concomitant Transthyretin Amyloid Cardiomyopathy in Older Adults with Severe Aortic Stenosis. Radiology 2023; 309:e230425. [PMID: 38085082 DOI: 10.1148/radiol.230425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Transthyretin amyloid cardiomyopathy (ATTR-CM) often coexists with severe aortic stenosis (AS). Although strain analysis from cardiac MRI and echocardiography was demonstrated to predict coexisting ATTR-CM, comparable data from four-dimensional (4D) cardiac CT are lacking despite wide availability. Purpose To evaluate the diagnostic performance of 4D cardiac CT-derived parameters in identifying ATTR-CM in older adults considered for transcatheter aortic valve implantation (TAVI). Materials and Methods This prospective single-center screening study for ATTR-CM included consecutive patients with severe AS considered for TAVI who underwent 4D cardiac CT between August 2019 and August 2021 approximately 1 day before technetium 99m (99mTc) 3,3-diphosphono-1,2-propanodicarboxylic-acid (DPD) scintigraphy. The diagnostic performance of CT-based left ventricular (LV), right ventricular, and left atrial dimensions, ejection fraction (EF), and myocardial strain were evaluated against 99mTc-DPD scintigraphy as the reference standard to identify ATTR-CM. Predictors and an unweighted cardiac CT score were validated with internal bootstrapping. The assignment of variables to the score was based on cutoff values achieving the highest Youden index J. Results Among 263 participants (mean age, 83 years ± 4.6 [SD]; 149 male and 114 female participants), 99mTc-DPD scintigraphy (Perugini grade 2 or 3) confirmed coexisting ATTR-CM in 27 (10.3%). CT-derived LV mass index, LV and LA global longitudinal strain (GLS), and relative apical longitudinal strain each predicted the presence of ATTR-CM with an area under the curve (AUC) of at least 0.70. Implementing these parameters with cutoff values of 81 g/m2 or higher, -14.9% or higher, less than 11.5%, and 1.7 or higher in the CT score, respectively, yielded high diagnostic performance (AUC = 0.89; 95% CI: 0.81, 0.94; P < .001) robust to internal bootstrapping validation (AUC = 0.88; 95% CI: 0.82, 0.94). If two criteria were fulfilled, the sensitivity and specificity in the detection of ATTR-CM were 96.3% (95% CI: 81.0, 99.9) and 58.9% (95% CI: 52.3, 65.2), respectively. Conclusion When compared against 99mTc-DPD scintigraphy as the reference standard, routine 4D cardiac CT in older adults considered for TAVI provided high diagnostic performance in the detection of concomitant ATTR-CM by assessing LV and left atrial GLS, relative apical longitudinal strain, and LV mass index. ClinicalTrials.gov registration no.: NCT04061213 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Tavakoli and Onder in this issue.
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Affiliation(s)
- Benedikt Bernhard
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Zoe Leib
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stephan Dobner
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Caglayan Demirel
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Federico Caobelli
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Axel Rominger
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Jonathan Schütze
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Hanna Grogg
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Louhai Alwan
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Giancarlo Spano
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Martina Boscolo Berto
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Jonas Lanz
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Thomas Pilgrim
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stephan Windecker
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stefan Stortecky
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Christoph Gräni
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
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Maier J, Lambert T, Senoner T, Dobner S, Hoppe UC, Fellner A, Pfeifer BE, Feuchtner GM, Friedrich G, Semsroth S, Bonaros N, Holfeld J, Müller S, Reinthaler M, Steinwender C, Barbieri F. Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement. Front Cardiovasc Med 2023; 10:1256112. [PMID: 38028449 PMCID: PMC10665844 DOI: 10.3389/fcvm.2023.1256112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Previous analyses have reported the outcomes of transcatheter aortic valve replacement (TAVR) for patients with low-flow, low-gradient (LFLG) aortic stenosis (AS), without stratifying according to the route of access. Differences in mortality rates among access routes have been established for high-gradient (HG) patients and hypothesized to be even more pronounced in LFLG AS patients. This study aims to compare the outcomes of patients with LFLG or HG AS following transfemoral (TF) or transapical (TA) TAVR. Methods A total of 910 patients, who underwent either TF or TA TAVR with a median follow-up of 2.22 (IQR: 1.22-4.03) years, were included in this multicenter cohort study. In total, 146 patients (16.04%) suffered from LFLG AS. The patients with HG and LFLG AS were stratified according to the route of access and compared statistically. Results The operative mortality rates of patients with HG and LFLG were found to be comparable following TF access. The operative mortality rate was significantly increased for patients who underwent TA access [odds ratio (OR): 2.91 (1.54-5.48), p = 0.001] and patients with LFLG AS [OR: 2.27 (1.13-4.56), p = 0.02], which could be corroborated in a propensity score-matched subanalysis. The observed increase in the risk of operative mortality demonstrated an additive effect [OR for TA LFLG: 5.45 (2.35-12.62), p < 0.001]. LFLG patients who underwent TA access had significantly higher operative mortality rates (17.78%) compared with TF LFLG (3.96%, p = 0.016) and TA HG patients (6.36%, p = 0.024). Conclusions HG patients experienced a twofold increase in operative mortality rates following TA compared with TF access, while LFLG patients had a fivefold increase in operative mortality rates. TA TAVR appears suboptimal for patients with LFLG AS. Prospective studies should be conducted to evaluate alternative options in cases where TF is not possible.
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Affiliation(s)
- Julian Maier
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
- Institute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler University Linz, Linz, Austria
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Thomas Lambert
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - Thomas Senoner
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 3rd Medical Department of Cardiology and Intensive Care Medicine, Clinic Ottakring (former Wilhelminenhospital), Vienna, Austria
| | - Uta Caroline Hoppe
- University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Fellner
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, Innsbruck, Austria
- Division of Digital Medicine and Telehealth, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
| | | | - Guy Friedrich
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Severin Semsroth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Silvana Müller
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Reinthaler
- Department of Cardiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Teltow, Germany
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
- Institute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler University Linz, Linz, Austria
| | - Fabian Barbieri
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
- Department of Cardiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Jaiswal V, Agrawal V, Khulbe Y, Hanif M, Huang H, Hameed M, Shrestha AB, Perone F, Parikh C, Gomez SI, Paudel K, Zacks J, Grubb KJ, De Rosa S, Gimelli A. Cardiac amyloidosis and aortic stenosis: a state-of-the-art review. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead106. [PMID: 37941729 PMCID: PMC10630099 DOI: 10.1093/ehjopen/oead106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
Cardiac amyloidosis is caused by the extracellular deposition of amyloid fibrils in the heart, involving not only the myocardium but also any cardiovascular structure. Indeed, this progressive infiltrative disease also involves the cardiac valves and, specifically, shows a high prevalence with aortic stenosis. Misfolded protein infiltration in the aortic valve leads to tissue damage resulting in the onset or worsening of valve stenosis. Transthyretin cardiac amyloidosis and aortic stenosis coexist in patients > 65 years in about 4-16% of cases, especially in those undergoing transcatheter aortic valve replacement. Diagnostic workup for cardiac amyloidosis in patients with aortic stenosis is based on a multi-parametric approach considering clinical assessment, electrocardiogram, haematologic tests, basic and advanced echocardiography, cardiac magnetic resonance, and technetium labelled cardiac scintigraphy like technetium-99 m (99mTc)-pyrophosphate, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, and 99mTc-hydroxymethylene diphosphonate. However, a biopsy is the traditional gold standard for diagnosis. The prognosis of patients with coexisting cardiac amyloidosis and aortic stenosis is still under evaluation. The combination of these two pathologies worsens the prognosis. Regarding treatment, mortality is reduced in patients with cardiac amyloidosis and severe aortic stenosis after undergoing transcatheter aortic valve replacement. Further studies are needed to confirm these findings and to understand whether the diagnosis of cardiac amyloidosis could affect therapeutic strategies. The aim of this review is to critically expose the current state-of-art regarding the association of cardiac amyloidosis with aortic stenosis, from pathophysiology to treatment.
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Affiliation(s)
- Vikash Jaiswal
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Vibhor Agrawal
- Department of Medicine, King George’s Medical University, Lucknow, India
| | - Yashita Khulbe
- Department of Medicine, King George’s Medical University, Lucknow, India
| | - Muhammad Hanif
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Helen Huang
- University of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maha Hameed
- Department of Internal Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Abhigan Babu Shrestha
- Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic ‘Villa delle Magnolie’,81020 Castel Morrone, Caserta, Italy
| | | | - Sabas Ivan Gomez
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Kusum Paudel
- Department of Medicine, Kathmandu University School of Medical Science, Dhulikhel, Kathmandu 45209, Nepal
| | - Jerome Zacks
- Department of Cardiology, The Icahn Medical School at Mount Sinai, NewYork 10128, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana/CNR Gabriele Monasterio, Pisa 56124, Italy
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Abadie B, Ali AH, Martyn T, Higgins A, Krishnaswamy A, Reed G, Puri R, Yun J, Cremer P, Hanna M, Tang WHW, Kapadia S, Jaber W. Prevalence of ATTR-CA and high-risk features to guide testing in patients referred for TAVR. Eur J Nucl Med Mol Imaging 2023; 50:3910-3916. [PMID: 37606857 DOI: 10.1007/s00259-023-06374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Transthyretin cardiac amyloidosis (ATTR-CA) is thought to be prevalent in patients with severe aortic stenosis (AS) who are referred for transcatheter aortic valve replacement (TAVR). However, prior studies were published when TAVR was only offered to elderly, inoperable, and high-risk patients. The aim of this study was to reevaluate the prevalence of ATTR-CA in a contemporary TAVR population and identify high-risk features to guide referral for technetium-99 pyrophosphate scan (99mTc-PyP scan) screening. METHODS Patients seen in a multidisciplinary TAVR clinic for severe AS 70 years and older were referred for a 99mTc-PyP scan to evaluate for ATTR-CA. The primary outcome was the percent with a positive scan. The discriminatory ability of high-risk features was assessed to develop a more judicious screening system. RESULTS Over the study period, 380 patients underwent screening, and 20 patients (5.3%) had a positive scan, with 17 patients having confirmed ATTR-CA, 1 patient deferring confirmatory testing (combined 4.7%), 1 having light chain amyloidosis, and 1 negative on biopsy. Compared to other patient and echocardiographic measures, elevated NT-pro BNP (> 1000 ng/L) was the best discriminator on who should be referred for 99mTc-PyP scan screening, with a sensitivity of 90% and a negative predictive value of 99%. CONCLUSION The prevalence of ATTR-CA may be lower in a contemporary TAVR population due to its expanded indication for low-risk patients. NT-pro BNP is a simple test that can improve screening yield and more judiciously guide screening for ATTR-CA in this at-risk population. Comparison of the original versus the proposed algorithm.
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Affiliation(s)
- Bryan Abadie
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Adel Hajj Ali
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Trejeeve Martyn
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrew Higgins
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Grant Reed
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rishi Puri
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - James Yun
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Paul Cremer
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mazen Hanna
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - W H Wilson Tang
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Samir Kapadia
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wael Jaber
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J1-5 Main Campus, Cleveland, OH, 44195, USA.
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Dweck MR, Loganath K, Bing R, Treibel TA, McCann GP, Newby DE, Leipsic J, Fraccaro C, Paolisso P, Cosyns B, Habib G, Cavalcante J, Donal E, Lancellotti P, Clavel MA, Otto CM, Pibarot P. Multi-modality imaging in aortic stenosis: an EACVI clinical consensus document. Eur Heart J Cardiovasc Imaging 2023; 24:1430-1443. [PMID: 37395329 DOI: 10.1093/ehjci/jead153] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
In this EACVI clinical scientific update, we will explore the current use of multi-modality imaging in the diagnosis, risk stratification, and follow-up of patients with aortic stenosis, with a particular focus on recent developments and future directions. Echocardiography is and will likely remain the key method of diagnosis and surveillance of aortic stenosis providing detailed assessments of valve haemodynamics and the cardiac remodelling response. Computed tomography (CT) is already widely used in the planning of transcutaneous aortic valve implantation. We anticipate its increased use as an anatomical adjudicator to clarify disease severity in patients with discordant echocardiographic measurements. CT calcium scoring is currently used for this purpose; however, contrast CT techniques are emerging that allow identification of both calcific and fibrotic valve thickening. Additionally, improved assessments of myocardial decompensation with echocardiography, cardiac magnetic resonance, and CT will become more commonplace in our routine assessment of aortic stenosis. Underpinning all of this will be widespread application of artificial intelligence. In combination, we believe this new era of multi-modality imaging in aortic stenosis will improve the diagnosis, follow-up, and timing of intervention in aortic stenosis as well as potentially accelerate the development of the novel pharmacological treatments required for this disease.
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Affiliation(s)
- Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Krithika Loganath
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Rong Bing
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Thomas A Treibel
- Barts Heart Centre, Bart's Health NHS Trust, W Smithfield, EC1A 7BE, London, UK
- University College London Institute of Cardiovascular Science, 62 Huntley St, WC1E 6DD, London, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, University Rd, Leicester LE1 7RH, UK
- The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, 1081 Burrard St Room 166, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Science and Public Health, Via Giustiniani, 2 - 35128, Padua, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan 164, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80125 Naples, Italy
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - João Cavalcante
- Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
| | - Erwan Donal
- Cardiology and CIC, Université Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes, France
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Corso Giuseppe Garibaldi, 11, 48022 Lugo RA, Italy
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
- Faculté de Médecine-Département de Médecine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, Quebec G1V 0A6, Canada
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, 4333 Brooklyn Ave NE Box 359458, Seattle, WA 98195-9458, USA
| | - Phillipe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
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Brito D, Albrecht FC, de Arenaza DP, Bart N, Better N, Carvajal-Juarez I, Conceição I, Damy T, Dorbala S, Fidalgo JC, Garcia-Pavia P, Ge J, Gillmore JD, Grzybowski J, Obici L, Piñero D, Rapezzi C, Ueda M, Pinto FJ. World Heart Federation Consensus on Transthyretin Amyloidosis Cardiomyopathy (ATTR-CM). Glob Heart 2023; 18:59. [PMID: 37901600 PMCID: PMC10607607 DOI: 10.5334/gh.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 10/31/2023] Open
Abstract
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive and fatal condition that requires early diagnosis, management, and specific treatment. The availability of new disease-modifying therapies has made successful treatment a reality. Transthyretin amyloid cardiomyopathy can be either age-related (wild-type form) or caused by mutations in the TTR gene (genetic, hereditary forms). It is a systemic disease, and while the genetic forms may exhibit a variety of symptoms, a predominant cardiac phenotype is often present. This document aims to provide an overview of ATTR-CM amyloidosis focusing on cardiac involvement, which is the most critical factor for prognosis. It will discuss the available tools for early diagnosis and patient management, given that specific treatments are more effective in the early stages of the disease, and will highlight the importance of a multidisciplinary approach and of specialized amyloidosis centres. To accomplish these goals, the World Heart Federation assembled a panel of 18 expert clinicians specialized in TTR amyloidosis from 13 countries, along with a representative from the Amyloidosis Alliance, a patient advocacy group. This document is based on a review of published literature, expert opinions, registries data, patients' perspectives, treatment options, and ongoing developments, as well as the progress made possible via the existence of centres of excellence. From the patients' perspective, increasing disease awareness is crucial to achieving an early and accurate diagnosis. Patients also seek to receive care at specialized amyloidosis centres and be fully informed about their treatment and prognosis.
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Affiliation(s)
- Dulce Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fabiano Castro Albrecht
- Dante Pazzanese Institute of Cardiology – Cardiac Amyloidosis Center Dante Pazzanese Institute, São Paulo, Brazil
| | | | - Nicole Bart
- St Vincent’s Hospital, Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia
| | - Nathan Better
- Cabrini Health, Malvern, Royal Melbourne Hospital, Parkville, Monash University and University of Melbourne, Victoria, Australia
| | | | - Isabel Conceição
- Department of Neurosciences and Mental Health, CHULN – Hospital de Santa Maria, Portugal
- Centro de Estudos Egas Moniz Faculdade de Medicina da Universidade de Lisboa Portugal, Portugal
| | - Thibaud Damy
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- CV imaging program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Julian D. Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, United Kingdom
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warsaw, Poland
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Rapezzi
- Cardiovascular Institute, University of Ferrara, Ferrara, Italy
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Fausto J. Pinto
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Mohty D, Omer MH, Ahmad O, Alayary I, Alzahrani T, Damy T, Fadel B. Transthyretin cardiac amyloidosis in Saudi Arabia and the Middle East: insights, projected prevalence and practical applications. Front Cardiovasc Med 2023; 10:1265681. [PMID: 37953763 PMCID: PMC10634293 DOI: 10.3389/fcvm.2023.1265681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Dania Mohty
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Mohamed H. Omer
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Omar Ahmad
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Islam Alayary
- Rare Diseases Medical Affairs, Pfizer Inc., Jeddah, Saudi Arabia
| | - Talal Alzahrani
- Department of Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia
| | - Thibaud Damy
- Referral Center for Cardiac Amyloidosis, Department of Cardiology, Mondor Amyloidosis Network, GRC Amyloid Research Institute, Clinical Investigation Center 006, DHU A-TVB INSERM U955 all at CHU Henri Mondor, UPEC, Créteil, France
| | - Bahaa Fadel
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
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San Román JA, Ybarra-Falcón C, García-Gómez M, Ramos N, Amat-Santos IJ, Sevilla T, Revilla A, Carrasco-Moraleja M, Lopez J, Cabezón G, Rollán MJ, Vilacosta I. Recurrence of syncope after valve replacement in severe aortic stenosis. Heart 2023; 109:1631-1638. [PMID: 37286345 DOI: 10.1136/heartjnl-2023-322859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE The recurrence of syncope after valve intervention in severe aortic stenosis (SAS) and its impact on outcome are unknown. We hypothesised that syncope on exertion will disappear after intervention, whereas syncope at rest might recur. Our aim has been to describe the recurrence of syncope in patients with SAS undergoing valve replacement and its impact on mortality. METHODS Double-centre observational registry of 320 consecutive patients with symptomatic SAS without other valve disease and/or coronary artery disease who underwent valve intervention and were discharged alive. All-cause mortality and cardiovascular mortality were considered events. RESULTS 53 patients (median age 81 years, 28 men) had syncope (29 on exertion, 21 at rest, 3 unknown). Clinical and echocardiographic variables were similar in patients with and without syncope (median vmax 4.44 m/s, mean gradient 47 mm Hg, valve area 0.7 cm2, left ventricular ejection fraction 62%). After a median follow-up of 69 months (IQR: 55-88), syncope on exertion did not recur in any patient. In contrast, 8 of the 21 patients with syncope at rest had postintervention syncope at rest (38%; p<0.001): 3 needed a pacemaker, 3 were neuromediated or hypotensive and 2 arrhythmic. Only recurrence of syncope was associated with cardiovascular mortality (HR 5.74; 95% CI 2.17 to 15.17; p<0.001). CONCLUSIONS Syncope on exertion in patients with SAS did not recur after aortic valve intervention. Syncope at rest recurs in a high proportion of patients and identifies a population with increased mortality. According to our results, syncope at rest should be thoroughly evaluated before proceeding to aortic valve intervention.
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Affiliation(s)
- J Alberto San Román
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
- Centro de Investigación Biomédica en Red. CIBER CV, Madrid, Spain
| | | | - Mario García-Gómez
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Noemí Ramos
- Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
- Centro de Investigación Biomédica en Red. CIBER CV, Madrid, Spain
| | - Teresa Sevilla
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
- Centro de Investigación Biomédica en Red. CIBER CV, Madrid, Spain
| | - Ana Revilla
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
- Centro de Investigación Biomédica en Red. CIBER CV, Madrid, Spain
| | - Manuel Carrasco-Moraleja
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
- Centro de Investigación Biomédica en Red. CIBER CV, Madrid, Spain
| | - Javier Lopez
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
- Centro de Investigación Biomédica en Red. CIBER CV, Madrid, Spain
| | - Gonzalo Cabezón
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - María Jesús Rollán
- Cardiology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Isidre Vilacosta
- Centro de Investigación Biomédica en Red. CIBER CV, Madrid, Spain
- Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain
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Koga M, Izumo M, Yoneyama K, Akashi YJ, Yashima F, Tada N, Yamawaki M, Shirai S, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Prognostic Value of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation: Insights from the OCEAN-TAVI Registry. Am J Cardiol 2023; 204:130-139. [PMID: 37541149 DOI: 10.1016/j.amjcard.2023.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
Electrocardiogram (ECG) left ventricular hypertrophy (LVH) is associated with the prognosis of patients with aortic stenosis. However, the impact of the presence or absence of ECG-LVH on the clinical outcomes after transcatheter aortic valve implantation (TAVI) is limited. This study aimed to assess the prognostic value of ECG-LVH among patients with aortic stenosis treated by TAVI. A total of 1,667 patients who underwent TAVI were prospectively enrolled into the OCEAN-TAVI (Optimized CathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation) registry. A total of 1,446 patients (mean age 84 years; 29.9% men) were analyzed. The Sokolow-Lyon index was used to determine the presence of ECG-LVH. LVH was also assessed using transthoracic echocardiography (TTE). We investigated the association between ECG-LVH and all-cause and cardiovascular mortality. This study identified ECG-LVH and TTE-LVH in 743 (51.5%) and 1,242 patients (86.0%), respectively. The Kaplan-Meier analysis revealed that all-cause mortality was significantly higher among patients without ECG-LVH than among those with ECG-LVH (log-rank p <0.001). In the multivariable analysis, the absence of ECG-LVH was independently associated with all-cause mortality (hazard ratio 1.98, 95% confidence interval 1.39 to 2.82, p <0.001), regardless of the presence or absence of TTE-LVH. Furthermore, the presence of TTE-LVH with the absence of ECG-LVH was observed in 575 patients (40%), which was associated with cardiovascular mortality (hazard ratio 2.84, 95% confidence interval 1.56 to 5.17, p <0.001). In conclusion, the absence of ECG-LVH was independently associated with an increased risk of all-cause mortality after TAVI. Risk stratification using both ECG-LVH and TTE-LVH is a useful predictor of adverse clinical outcomes after TAVI.
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Affiliation(s)
- Masashi Koga
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Kihei Yoneyama
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shinichi Shirai
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University Hospital, Toyama, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Aimo A, Fabiani I, Maccarana A, Vergaro G, Chubuchny V, Pasanisi EM, Petersen C, Poggianti E, Giannoni A, Spini V, Taddei C, Castiglione V, Passino C, Fontana M, Emdin M, Venneri L. Valve disease in cardiac amyloidosis: an echocardiographic score. Int J Cardiovasc Imaging 2023; 39:1873-1887. [PMID: 37341947 PMCID: PMC10589146 DOI: 10.1007/s10554-023-02901-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/14/2023] [Indexed: 06/22/2023]
Abstract
Cardiac amyloidosis (CA) may affect all cardiac structures, including the valves. From 423 patients undergoing a diagnostic workup for CA we selected 2 samples of 20 patients with amyloid transthyretin (ATTR-) or light-chain (AL-) CA, and age- and sex-matched controls. We chose 31 echocardiographic items related to the mitral, aortic and tricuspid valves, giving a value of 1 to each abnormal item. Patients with ATTR-CA displayed more often a shortened/hidden and restricted posterior mitral valve leaflet (PMVL), thickened mitral chordae tendineae and aortic stenosis than those with AL-CA, and less frequent PMVL calcification than matched controls. Score values were 15.8 (13.6-17.4) in ATTR-CA, 11.0 (9.3-14.9) in AL-CA, 12.8 (11.1-14.4) in ATTR-CA controls, and 11.0 (9.1-13.0) in AL-CA controls (p = 0.004 for ATTR- vs. AL-CA, 0.009 for ATTR-CA vs. their controls, and 0.461 for AL-CA vs. controls). Area under the curve values to diagnose ATTR-CA were 0.782 in patients with ATTR-CA or matched controls, and 0.773 in patients with LV hypertrophy. Patients with ATTR-CA have a prominent impairment of mitral valve structure and function, and higher score values. The valve score may help identify patients with ATTR-CA among patients with CA or unexplained hypertrophy.
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Affiliation(s)
- Alberto Aimo
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy.
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Agnese Maccarana
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
| | - Giuseppe Vergaro
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
| | | | | | - Christina Petersen
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Elisa Poggianti
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alberto Giannoni
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
| | - Valentina Spini
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudia Taddei
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Vincenzo Castiglione
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
| | - Claudio Passino
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Michele Emdin
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
| | - Lucia Venneri
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
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Hussain B, Duhan S, Mahmood A, Al-Alawi L, Vargas C, Khan S, Ali Z, Waqar F, Alfonso C, Cuevas C, Alexander T. Prevalence and Prognostic Implications of Amyloidosis in Valvular Heart Disease. Curr Probl Cardiol 2023; 48:101811. [PMID: 37209794 DOI: 10.1016/j.cpcardiol.2023.101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
There has been less emphasis on the prognostic impact of amyloidosis in patients with valvular heart disease (VHD). We aimed to determine the prevalence of amyloidosis in VHD and its clinical implications in terms of mortality. Patients hospitalized for VHD were identified using National Inpatient Sample 2016-2020 which were divided into 2 cohorts: with and without amyloidosis. Among 5,728,873 patients hospitalized with VHD, 11,715 patients had amyloidosis in which mitral valve disease has the highest prevalence (7.6%) followed by aortic (3.6%), and tricuspid valve disease (1%). Underlying amyloidosis is associated with higher mortality in VHD (OR 1.45, CI 1.2-1.7, P<0.001), mainly mitral valve disease (OR 1.44, CI 1.1-1.9, P<0.01). Patients with amyloidosis have higher adjusted mortality rates (5-6% vs 2.6%, P<0.01), longer mean length of stay (7.1 vs 5.7 days, P<0.001), but they have lower valvular intervention rates. In hospitalized VHD patients, underlying amyloidosis is associated with higher in-hospital mortality.
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Affiliation(s)
- Bilal Hussain
- The Brooklyn Hospital Center, Internal Medicine, Brooklyn, NY.
| | - Sanchit Duhan
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Ahmed Mahmood
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
| | - Luay Al-Alawi
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
| | - Carlos Vargas
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
| | - Sohail Khan
- Interventional Cardiology, Marshfield Medical Center, Marshfield, WI
| | - Zuhair Ali
- Graduate Medical Education, HCA Houston Healthcare, Houston, TX
| | - Fahad Waqar
- Interventional Cardiology, University of Cincinnati, Cincinnati, OH
| | | | - Christel Cuevas
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
| | - Thomas Alexander
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
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47
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Ravassa S, López B, Treibel TA, San José G, Losada-Fuentenebro B, Tapia L, Bayés-Genís A, Díez J, González A. Cardiac Fibrosis in heart failure: Focus on non-invasive diagnosis and emerging therapeutic strategies. Mol Aspects Med 2023; 93:101194. [PMID: 37384998 DOI: 10.1016/j.mam.2023.101194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
Heart failure is a leading cause of mortality and hospitalization worldwide. Cardiac fibrosis, resulting from the excessive deposition of collagen fibers, is a common feature across the spectrum of conditions converging in heart failure. Eventually, either reparative or reactive in nature, in the long-term cardiac fibrosis contributes to heart failure development and progression and is associated with poor clinical outcomes. Despite this, specific cardiac antifibrotic therapies are lacking, making cardiac fibrosis an urgent unmet medical need. In this context, a better patient phenotyping is needed to characterize the heterogenous features of cardiac fibrosis to advance toward its personalized management. In this review, we will describe the different phenotypes associated with cardiac fibrosis in heart failure and we will focus on the potential usefulness of imaging techniques and circulating biomarkers for the non-invasive characterization and phenotyping of this condition and for tracking its clinical impact. We will also recapitulate the cardiac antifibrotic effects of existing heart failure and non-heart failure drugs and we will discuss potential strategies under preclinical development targeting the activation of cardiac fibroblasts at different levels, as well as targeting additional extracardiac processes.
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Affiliation(s)
- Susana Ravassa
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Begoña López
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Gorka San José
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Blanca Losada-Fuentenebro
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Leire Tapia
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Antoni Bayés-Genís
- CIBERCV, Carlos III Institute of Health, Madrid, Spain; Servei de Cardiologia i Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute, Badalona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain.
| | - Arantxa González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain.
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48
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Gaznabi S, Miranda J, Lorenzatti D, Piña P, Balasubramanian SS, Desai D, Desai A, Ho EC, Scotti A, Gongora CA, Schenone AL, Garcia MJ, Latib A, Parwani P, Slipczuk L. Multimodality Imaging in Aortic Stenosis: Beyond the Valve - Focusing on the Myocardium. Heart Fail Clin 2023; 19:491-504. [PMID: 37714589 DOI: 10.1016/j.hfc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Current guidelines of aortic stenosis (AS) management focus on valve parameters, LV systolic dysfunction, and symptoms; however, emerging data suggest that there may be benefit of aortic valve replacement before it becomes severe by present criteria. Myocardial assessment using novel multimodality imaging techniques exhibits subclinical myocardial injury and remodeling at various stages before guideline-directed interventions, which predicts adverse outcomes. This raises the question of whether implementing serial myocardial assessment should become part of the standard appraisal, thereby identifying high-risk patients aiming to minimize adverse outcomes.
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Affiliation(s)
- Safwan Gaznabi
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, University of Chicago at Northshore University Health System, 1000 Central Street, Evanston, IL 60201, USA
| | - Jeirym Miranda
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, Mount Sinai Morningside. 419 West 114th Street, NY 10025, USA
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, CEDIMAT. Arturo Logroño, Plaza de la Salud, Dr. Juan Manuel Taveras Rodríguez, C. Pepillo Salcedo esq. Santo Domingo, Dominican Republic
| | - Senthil S Balasubramanian
- Division of Cardiology, University of Chicago at Northshore University Health System, 1000 Central Street, Evanston, IL 60201, USA
| | - Darshi Desai
- Department of Internal Medicine, University of California Riverside School of Medicine. 900 University Avenue, Riverside, CA 92521, USA
| | - Aditya Desai
- Department of Internal Medicine, University of California Riverside School of Medicine. 900 University Avenue, Riverside, CA 92521, USA
| | - Edwin C Ho
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Carlos A Gongora
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, 11234 Anderson Street, Loma Linda, CA 92354, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA.
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49
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Jaiswal V, Joshi A, Ishak A, Nataraj M, Ang SP, Khan N, Daneshvar F, Aguilera-Alvarez VH, Verma D, Shrestha AB, Sharma P. Meta-analysis of post-transcatheter aortic valve replacement outcomes in patients with cardiac amyloidosis and aortic stenosis. Int J Surg 2023; 109:2872-2874. [PMID: 37300891 PMCID: PMC10498851 DOI: 10.1097/js9.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Affiliation(s)
| | - Amey Joshi
- Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Angela Ishak
- European University Cyprus, School of Medicine, Nicosia, Cyprus
| | - Megha Nataraj
- Cardio-Pulmonary Physiotherapist and Research, Manipal, Karnataka, India
| | - Song P. Ang
- Division of Internal Medicine, Rutgers Health/Community Medical Center, New Jersey, USA
| | - Nida Khan
- Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | | | - Abhigan B. Shrestha
- Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Prachi Sharma
- Division of Cardiology, Department of Internal Medicine, King George's Medical University, India
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50
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Tana M, Tana C, Palmiero G, Mantini C, Coppola MG, Limongelli G, Schiavone C, Porreca E. Imaging findings of right cardiac amyloidosis: impact on prognosis and clinical course. J Ultrasound 2023; 26:605-614. [PMID: 37162729 PMCID: PMC10171176 DOI: 10.1007/s40477-023-00789-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/04/2023] [Indexed: 05/11/2023] Open
Abstract
Cardiac involvement from amyloidosis is of growing interest in the overall literature. Despite cardiac amyloidosis (CA) has been considered for a long time a rare disease, the diagnostic awareness is increasing mainly thanks to the improvement of diagnostic softwares and of imaging techniques such as cardiac magnetic resonance (CMR). Some authors have observed an increase of prevalence rate of CA; moreover it's often underestimated because clinical manifestations are aspecific. The interstitial infiltration of the left ventricle has been extensively studied, while the involvement of the right ventricle (RV) has been less investigated. Involvement of the RV, even in the absence of pulmonary hypertension or clearly left ventricle infiltration, plays an important role as prognostic factor and is useful to achieve an early diagnosis. Therefore, the use of fast and low-cost diagnostic methods such as ultrasound strain of the right ventricle could be used to recognize cardiac amyloidosis early. Herein the importance of evaluating the right ventricular involvement, which can predict the most severe course of the disease also without overt clinical manifestations. The role of imaging, in particular of echocardiography, CMR, and scintigraphy is here reported.
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Affiliation(s)
- Marco Tana
- Internal Medicine Unit, Medical Department, SS. Annunziata Hospital of Chieti, Via Dei Vestini 31, 66100, Chieti, Italy.
- Cardiovascular Ultrasound Department, SS. Annunziata Hospital, Chieti, Italy.
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Claudio Tana
- COVID-19 Medicine Unit and Geriatrics Clinic, Medical Department, SS. Annunziata Hospital, Chieti, Italy
| | - Giuseppe Palmiero
- Rare Cardiac Disease Unit, Department of Translational Medical Sciences, "Luigi Vanvitelli" University, Naples, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | | | - Giuseppe Limongelli
- Rare Cardiac Disease Unit, Department of Translational Medical Sciences, "Luigi Vanvitelli" University, Naples, Italy
| | | | - Ettore Porreca
- Internal Medicine Unit, Medical Department, SS. Annunziata Hospital of Chieti, Via Dei Vestini 31, 66100, Chieti, Italy
- Cardiovascular Ultrasound Department, SS. Annunziata Hospital, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
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