Myasoedova Veronika A, Conte Maddalena, Valerio Vincenza, Moschetta Donato, Massaiu Ilaria, Petraglia Laura, Leosco Dario, Poggio Paolo, Parisi Valentina
Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.
Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy.
Front Med (Lausanne). 2022 Mar 9;9:858281. doi: 10.3389/fmed.2022.858281. eCollection 2022.
Cardiac amyloidosis (CA) has been recently recognized as a condition frequently associated with aortic stenosis (AS). The aim of this study was to evaluate: the main characteristics of patients with AS with and without CA, the impact of CA on patients with AS mortality, and the effect of different treatment strategies on outcomes of patients with AS with concomitant CA.
A detailed search related to CA in patients with AS and outcomes was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies enrolling 1,988 subjects (1,658 AS alone and 330 AS with CA) were included in the qualitative and quantitative analysis of main patients with AS characteristics with and without CA, difference in mortality, and treatment strategy.
The prevalence of CA resulted in a mean of 15.4% and it was even higher in patients with AS over 80 years old (18.2%). Patients with the dual diagnosis were more often males, had lower body mass index (BMI), were more prone to have low flow, low gradient with reduced left ventricular ejection fraction AS phenotype, had higher E/A and E/e', and greater interventricular septum hypertrophy. Lower Sokolow-Lyon index, higher QRS duration, higher prevalence of right bundle branch block, higher levels of -terminal pro-brain natriuretic peptide, and high-sensitivity troponin T were significantly associated with CA in patients with AS. Higher overall mortality in the 178 patients with AS + CA in comparison to 1,220 patients with AS alone was observed [odds ratio (OR) 2.25, = 0.004]. Meta-regression analysis showed that younger age and diabetes were associated with overall mortality in patients with CS with CA (-value -3.0, = 0.003 and -value 2.5, = 0.013, respectively). Finally, patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) had a similar overall mortality risk, but lower than medication-treated only patients.
Results from our meta-analysis suggest that several specific clinical, electrocardiographic, and echocardiographic features can be considered "red flags" of CA in patients with AS. CA negatively affects the outcome of patients with AS. Patients with concomitant CA and AS benefit from SAVR or TAVI.
心脏淀粉样变性（CA）最近被认为是一种常与主动脉瓣狭窄（AS）相关的疾病。本研究的目的是评估：合并和不合并CA的AS患者的主要特征、CA对AS患者死亡率的影响以及不同治疗策略对合并CA的AS患者预后的影响。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，对AS患者中与CA及预后相关的研究进行了详细检索。17项研究共纳入1988名受试者（1658名单纯AS患者和330名合并CA的AS患者），对合并和不合并CA的AS患者的主要特征、死亡率差异及治疗策略进行定性和定量分析。
CA的患病率平均为15.4%，在80岁以上的AS患者中甚至更高（18.2%）。双重诊断的患者男性居多，体重指数（BMI）较低，更易出现低流量、低梯度伴左心室射血分数降低的AS表型，E/A和E/e'更高，室间隔肥厚更明显。较低的索科洛夫-里昂指数、较长的QRS时限、较高的右束支传导阻滞患病率、较高的N末端脑钠肽前体水平和高敏肌钙蛋白T与AS患者的CA显著相关。与1220名单纯AS患者相比，178名合并CA的AS患者的总体死亡率更高[比值比（OR）2.25，P = 0.004]。Meta回归分析显示，年龄较小和糖尿病与合并CA的CS患者的总体死亡率相关（P值分别为-3.0，P = 0.003和P值2.5，P = 0.013）。最后，接受外科主动脉瓣置换术（SAVR）或经导管主动脉瓣植入术（TAVI）的患者总体死亡风险相似，但低于仅接受药物治疗的患者。
我们的Meta分析结果表明，一些特定的临床、心电图和超声心动图特征可被视为AS患者CA的“警示信号”。CA对AS患者的预后有负面影响。合并CA和AS的患者从SAVR或TAVI中获益。
