Rosenblum Hannah, Masri Ahmad, Narotsky David L, Goldsmith Jeff, Hamid Nadira, Hahn Rebecca T, Kodali Susheel, Vahl Torsten, Nazif Tamim, Khalique Omar K, Bokhari Sabahat, Soman Prem, Cavalcante João L, Maurer Mathew S, Castaño Adam
Center for Cardiac Amyloidosis, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA.
The Amyloidosis Center, Division of Cardiology, Oregon Health & Sciences University, Portland, OR, USA.
Eur J Heart Fail. 2021 Feb;23(2):250-258. doi: 10.1002/ejhf.1974. Epub 2020 Sep 8.
Advances in diagnostic imaging have increased the recognition of coexisting transthyretin cardiac amyloidosis (ATTR-CA) and severe aortic stenosis (AS), with a reported prevalence between 8-16%. In this prospective study, we aimed to evaluate the implications of ATTR-CA on outcomes after transcatheter aortic valve replacement (TAVR).
At two academic centres, we screened patients with severe AS undergoing TAVR for ATTR-CA. Using Kaplan-Meier analysis, we compared survival free from death and a combined endpoint of death and first heart failure hospitalization between patients with and without ATTR-CA. Cox proportional-hazards models were used to determine the association of ATTR-CA with these endpoints. The rate of heart failure hospitalization was compared amongst those with and without ATTR-CA. Overall, 204 patients (83 years, 65% male, Society of Thoracic Surgeons score 6.6%, 72% New York Heart Association class III/IV) were included, 27 (13%) with ATTR-CA. Over a median follow-up of 2.04 years, there was no difference in mortality (log rank, P = 0.99) or the combined endpoint (log rank, P = 0.79) between patients with and without ATTR-CA. In Cox proportional-hazards models, the presence of ATTR-CA was not associated with death. However, patients with ATTR-CA had increased rates of heart failure hospitalization at 1 year (0.372 vs. 0.114 events/person-year, P < 0.004) and 3 years (0.199 vs. 0.111 events/person-year, P = 0.087) following TAVR.
In moderate-risk patients with severe AS undergoing TAVR, there was a 13% prevalence of ATTR-CA, which did not affect mortality. The observed increase in heart failure hospitalization following TAVR in those with ATTR-CA suggests the consequences of the underlying infiltrative myopathy.
诊断成像技术的进步提高了对共存的转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）和严重主动脉瓣狭窄（AS）的认识，据报道其患病率在8%-16%之间。在这项前瞻性研究中，我们旨在评估ATTR-CA对经导管主动脉瓣置换术（TAVR）后结局的影响。
在两个学术中心，我们对接受TAVR的严重AS患者进行了ATTR-CA筛查。使用Kaplan-Meier分析，我们比较了有和没有ATTR-CA的患者的无死亡生存率以及死亡和首次心力衰竭住院的综合终点。使用Cox比例风险模型来确定ATTR-CA与这些终点的关联。比较了有和没有ATTR-CA的患者的心力衰竭住院率。总体而言，纳入了204例患者（83岁，65%为男性，胸外科医师协会评分6.
