Lee Dae Hyun, Eichelberger Gerry S, Patel Vandan, Chhaya Ronak, Khadilkar Arjun, Bishop Jennifer, Bezerra Hiram, Oliveira Guilherme, Matar Fadi, Fernandez Joel
Department of Cardiovascular Medicine, University of South Florida, Tampa, USA.
Department of Internal Medicine, University of South Florida, Tampa, USA.
Cureus. 2023 Sep 11;15(9):e45024. doi: 10.7759/cureus.45024. eCollection 2023 Sep.
Background Transthyretin cardiac amyloidosis (ATTR) is an important comorbidity present in severe aortic stenosis (AS). The purpose of this study was to raise awareness of ATTR in patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS among healthcare providers and patients. Methodology We reviewed 197 consecutive TAVR cases performed from 2019 to 2020. Adapting predefined high-risk features for ATTR based on prior literature, we contacted the patients to discuss our clinical suspicion of ATTR and offered a referral to a cardiac amyloid specialist. Results We identified 125 (69.4%) patients who had high-risk features of ATTR. Of the 105 patients contacted, 44 patients agreed to referral, 46 patients were not able to be contacted after several attempts, and 15 patients declined referral. Of the 44 patients who agreed to the referral, 20 patients completed the evaluation for cardiac amyloidosis, all of whom were negative for transthyretin and light-chain cardiac amyloidosis. Conclusions Our attempt to detect ATTR in prior TAVR patients was unsuccessful two to three years post-TAVR. We believe that early detection of cardiac amyloidosis close to the timing of TAVR is important and the most effective means.
转甲状腺素蛋白心脏淀粉样变性（ATTR）是严重主动脉瓣狭窄（AS）中存在的一种重要合并症。本研究的目的是提高医疗服务提供者和患者对重度AS患者经导管主动脉瓣置换术（TAVR）后ATTR的认识。方法：我们回顾了2019年至2020年连续进行的197例TAVR病例。根据先前文献改编了针对ATTR的预定义高危特征，我们联系患者以讨论我们对ATTR的临床怀疑，并提供转介至心脏淀粉样变性专家的服务。结果：我们确定了125例（69.4%）具有ATTR高危特征的患者。在联系的105例患者中，44例患者同意转介，46例患者经多次尝试后无法联系到，15例患者拒绝转介。在同意转介的44例患者中，20例患者完成了心脏淀粉样变性评估，所有患者转甲状腺素蛋白和轻链心脏淀粉样变性均为阴性。结论：我们在TAVR术后两到三年检测既往TAVR患者ATTR的尝试未成功。我们认为在接近TAVR时机时早期检测心脏淀粉样变性很重要且是最有效的方法。
