Voß Fabian, Zweck Elric, Haurand Jean Marc, Haschemi Jafer, Jung Christian, Zeus Tobias, Klein Kathrin, Westenfeld Ralf, Angendohr Stephan, Fenk Roland, Pfister Roman, Spieker Maximilian, Kelm Malte, Polzin Amin, Scheiber Daniel
Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
Abiomed Europe GmbH Europe, Neunhofer Weg 3, 52074, Aachen, Germany.
Cardiooncology. 2025 Sep 24;11(1):81. doi: 10.1186/s40959-025-00383-w.
Cardiac Amyloidosis (CA) remains highly underdiagnosed, especially among patients with causes of increased ventricular wall thickness, such as aortic stenosis (AS). The prevalence of CA throughout the spectrum of mild to severe AS is unknown and specific validated diagnostic parameters for this population are lacking. Here, we propose and prospectively evaluate a screening algorithm for CA among patients with mild to severe AS.
In this prospective, single-center study (NCT05010980), we included patients ≥ 65 years with mild to severe AS, an interventricular septum thickness > 11 mm, and at least one of the following criteria: Sokolow-Lyon-Index to left ventricular mass index ratio < 1.6 or stroke volume index < 35 ml/m2. Participants were prospectively screened for CA according to current guideline recommendations.
After screening 2126 patients of whom 187 were eligible, 57 participants were enrolled and completed the diagnostic work-up. Mean age was 83 ± 0.7 years and 71% were male. 30% of the participants had mild, 37% had moderate and 33% had severe AS, respectively. Overall 26% of participants were diagnosed with CA. The prevalence of CA was higher among patients with mild AS (41%) compared to participants with moderate (24%) or severe AS (16%, p = 0.01). Within this preselected patient population, troponin (AUC:0.9, p < 0.0001) and NT-proBNP (AUC:0.86, p < 0.0001) further improved discrimination of patients with and without CA.
The prevalence of CA among AS patients fulfilling the preselected inclusion criteria was high, especially among those with mild to moderate AS. Implementing these criteria in clinical protocols could improve early diagnosis of CA.
心脏淀粉样变性（CA）的诊断率仍然很低，尤其是在心室壁厚度增加的病因患者中，如主动脉瓣狭窄（AS）。轻度至重度AS患者中CA的患病率尚不清楚，且缺乏针对该人群的经过验证的特异性诊断参数。在此，我们提出并前瞻性评估一种针对轻度至重度AS患者的CA筛查算法。
在这项前瞻性单中心研究（NCT05010980）中，我们纳入了年龄≥65岁、患有轻度至重度AS、室间隔厚度>11mm且符合以下至少一项标准的患者：Sokolow-Lyon指数与左心室质量指数之比<1.6或每搏输出量指数<35ml/m²。根据当前指南建议对参与者进行CA的前瞻性筛查。
在筛查的2126例患者中，187例符合条件，57例参与者被纳入并完成了诊断检查。平均年龄为83±0.7岁，71%为男性。分别有30%的参与者患有轻度AS，37%患有中度AS，33%患有重度AS。总体而言，26%的参与者被诊断为CA。与中度（24%）或重度AS（16%，p=0.01）的参与者相比，轻度AS患者中CA的患病率更高（41%）。在这个预先选择的患者群体中，肌钙蛋白（AUC：0.9，p<0.0001）和N末端脑钠肽前体（AUC：0.86，p<0.0001）进一步提高了对有或无CA患者的鉴别能力。
符合预先选择纳入标准的AS患者中CA的患病率很高，尤其是轻度至中度AS患者。在临床方案中实施这些标准可改善CA的早期诊断。
