Reverse Remodeling Following Valve Replacement in Coexisting Aortic Stenosis and Transthyretin Cardiac Amyloidosis

Christian Nitsche, Matthias Koschutnik, Carolina Donà, Richard Radun, Katharina Mascherbauer, Andreas Kammerlander, Gregor Heitzinger, Varius Dannenberg, Georg Spinka, Kseniya Halavina, Max-Paul Winter, Raffaella Calabretta, Marcus Hacker, Hermine Agis, Raphael Rosenhek, Philipp Bartko, Christian Hengstenberg, Thomas Treibel, Julia Mascherbauer, Georg Goliasch

Research output: Journal article (peer-reviewed)Journal article

1 Citation (Scopus)

Abstract

BACKGROUND: Dual pathology of severe aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR) is increasingly recognized. Evolution of symptoms, biomarkers, and myocardial mechanics in AS-ATTR following valve replacement is unknown. We aimed to characterize reverse remodeling in AS-ATTR and compared with lone AS.

METHODS: Consecutive patients referred for transcatheter aortic valve replacement (TAVR) underwent ATTR screening by blinded 99mTc-DPD bone scintigraphy (Perugini Grade-0 negative, 1-3 increasingly positive) before intervention. ATTR was diagnosed by DPD and absence of monoclonal protein. Reverse remodeling was assessed by comprehensive evaluation before TAVR and at 1 year.

RESULTS: One hundred twenty patients (81.8±6.3 years, 51.7% male, 95 lone AS, 25 AS-ATTR) with complete follow-up were studied. At 12 months (interquartile range, 7-17) after TAVR, both groups experienced significant symptomatic improvement by New York Heart Association functional class (both P<0.001). Yet, AS-ATTR remained more symptomatic (New York Heart Association ≥III: 36.0% versus 13.8; P=0.01) with higher residual NT-proBNP (N-terminal pro-brain natriuretic peptide) levels (P<0.001). Remodeling by echocardiography showed left ventricular mass regression only for lone AS (P=0.002) but not AS-ATTR (P=0.5). Global longitudinal strains improved similarly in both groups. Conversely, improvement of regional longitudinal strain showed a base-to-apex gradient in AS-ATTR, whereas all but apical segments improved in lone AS. This led to the development of an apical sparing pattern in AS-ATTR only after TAVR.

CONCLUSIONS: Patterns of reverse remodeling differ from lone AS to AS-ATTR, with both groups experiencing symptomatic improvement by TAVR. After AS treatment, AS-ATTR transfers into a lone ATTR cardiomyopathy phenotype.

Original languageEnglish
Pages (from-to)e014115
JournalCirculation: Cardiovascular Imaging
Volume15
Issue number7
DOIs
Publication statusPublished - 1 Jul 2022

Keywords

  • Aged
  • Aged, 80 and over
  • Amyloid Neuropathies, Familial/complications
  • Aortic Valve/diagnostic imaging
  • Aortic Valve Stenosis/complications
  • Cardiomyopathies/complications
  • Female
  • Humans
  • Male
  • Prealbumin
  • Transcatheter Aortic Valve Replacement
  • Treatment Outcome
  • phenotype
  • echocardiography
  • biomarker
  • amyloid
  • cardiomyopathy
  • male

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology, Nuclear Medicine and Imaging

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