Unveiling Cardiac Amyloidosis, its Characteristics, and Outcomes Among Patients With MR Undergoing Transcatheter Edge-to-Edge MV Repair

Carolina Donà, Christian Nitsche, Matthias Koschutnik, Gregor Heitzinger, Katharina Mascherbauer, Andreas A Kammerlander, Varius Dannenberg, Kseniya Halavina, René Rettl, Franz Duca, Tatjana Traub-Weidinger, Juergen Puchinger, Petra C Gunacker, Gudrun Lamm, Paul Vock, Brigitte Lileg, Vyhnanek Philipp, Anton Staudenherz, Raffaella Calabretta, Marcus HackerHermine Agis, Philipp Bartko, Christian Hengstenberg, Marianna Fontana, Georg Goliasch, Julia Mascherbauer

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

10 Citations (Scopus)


BACKGROUND: Mitral regurgitation (MR) and cardiac amyloidosis (CA) both primarily affect older patients. Data on coexistence and prognostic implications of MR and CA are currently lacking.

OBJECTIVES: This study sought to identify the prevalence, clinical characteristics, and outcomes of MR CA compared with lone MR.

METHODS: Consecutive patients undergoing transcatheter edge-to-edge repair (TEER) for MR at 2 sites were screened for concomitant CA using a multiparametric approach including core laboratory 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid bone scintigraphy and echocardiography and immunoglobulin light chain assessment. Transthyretin CA (ATTR) was diagnosed by 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (Perugini grade 1: early infiltration; grades 2/3: clinical CA) and the absence of monoclonal protein, and light chain (AL) CA via tissue biopsy. All-cause mortality and hospitalization for heart failure (HHF) served as the endpoints.

RESULTS: A total of 120 patients (age 76.9 ± 8.1 years, 55.8% male) were recruited. Clinical CA was diagnosed in 14 patients (11.7%; 12 ATTR, 1 AL, and 1 combined ATTR/AL) and early amyloid infiltration in 9 patients (7.5%). Independent predictors of MR CA were increased posterior wall thickness and the presence of a left anterior fascicular block on electrocardiography. Procedural success and periprocedural complications of TEER were similar in MR CA and lone MR (P for all = NS). After a median of 1.7 years, 25.8% had experienced death and/or HHF. MR CA had worse outcomes compared with lone MR (HR: 2.2; 95% CI: 1.0-4.7; P = 0.034), driven by a 2.5-fold higher risk for HHF (HR: 2.5; 95% CI: 1.1-5.9), but comparable mortality (HR: 1.6; 95% CI: 0.4-6.1).

CONCLUSIONS: Dual pathology of MR CA is common in elderly patients with MR undergoing TEER and has worse postinterventional outcomes compared with lone MR.

Original languageEnglish
Pages (from-to)1748-1758
Number of pages11
JournalJACC: Cardiovascular Interventions
Issue number17
Early online date17 Aug 2022
Publication statusPublished - 12 Sept 2022


  • cardiac amyloidosis
  • mitral regurgitation
  • transcatheter edge-to-edge repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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