Academic Foundation Programme, North Middlesex University Hospital NHS Trust, United Kingdom.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Hellenic J Cardiol. 2022 Mar-Apr;64:67-76. doi: 10.1016/j.hjc.2021.11.001. Epub 2021 Nov 29.
Cardiac amyloidosis (CA) is an increasingly recognised condition in patients with aortic stenosis (AS). However, there is a large variation in the reported prevalence figures, due to differences in populations and diagnostic methods. We aimed to investigate the prevalence, risk factors and outcomes of concomitant CA and AS.
We performed a systematic review and meta-analysis of the literature searched on MEDLINE, Embase, Scopus and CENTRAL. We analysed the prevalence of CA in patients with AS grouped according to the diagnostic techniques, and the risk factors and outcomes of concomitant CA and AS were analysed in AS patients referred for surgical or transcatheter aortic valve replacement (AVR).
A total of 21 studies were included, involving 4,243 patients. The pooled prevalence of CA in patients with AS was 14.4%, with substantial heterogeneity. The pooled prevalence of AS in patients CA was 8.7%, with substantial heterogeneity. Patients with both AS and CA had higher all-cause mortality than those with AS or CA alone. In AS patients requiring AVR, CA was associated with increasing age, male sex, higher NT-proBNP levels, increased interventricular septal end diastole (IVSd) thickness and lower left ventricular ejection fraction. Concomitant AS and CA was associated with increased all-cause mortality and pacemaker implantation post-procedure. Study limitations included heterogeneity of the results and the fair to good quality of the studies published.
Overall, a substantial proportion of patients with AS may have CA, and they have poorer prognosis. A high degree of clinical suspicion is needed to identify the "red flags" and perform appropriate diagnostic imaging.
心脏淀粉样变（CA）是主动脉瓣狭窄（AS）患者中越来越被认识的一种疾病。然而，由于人群和诊断方法的差异，报告的患病率数据存在很大差异。我们旨在研究同时患有 CA 和 AS 的患者的患病率、危险因素和结局。
我们对 MEDLINE、Embase、Scopus 和 CENTRAL 上检索到的文献进行了系统评价和荟萃分析。我们根据诊断技术分析了 AS 患者中 CA 的患病率，并分析了接受外科或经导管主动脉瓣置换术（AVR）的 AS 患者中同时患有 CA 和 AS 的危险因素和结局。
共纳入 21 项研究，涉及 4243 例患者。AS 患者中 CA 的总患病率为 14.4%，存在很大的异质性。CA 患者中 AS 的总患病率为 8.7%，存在很大的异质性。同时患有 AS 和 CA 的患者的全因死亡率高于仅患有 AS 或 CA 的患者。在需要 AVR 的 AS 患者中，CA 与年龄较大、男性、较高的 NT-proBNP 水平、舒张末期室间隔厚度增加和左心室射血分数降低有关。同时患有 AS 和 CA 与全因死亡率增加和术后植入起搏器有关。研究局限性包括结果的异质性和已发表研究的质量为中等至良好。
总体而言，相当一部分 AS 患者可能患有 CA，且预后较差。需要高度的临床怀疑来识别“危险信号”并进行适当的诊断影像学检查。
