SPC365

Screening for Cardiac Amyloidosis in Patients undergoing Transcatheter Aortic Valve Implantation (TAVI)

Session: Posters (Sessão 2 - Écran 4) - Doença valvular
Speaker: André Lobo

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.7 Valvular Heart Disease - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Andre Lobo; Marta Catarina Almeida; Silvia Diaz; Francisco Sampaio; António Barros; Francisca Saraiva; Bruno Melica; Mariana Brandão; Diogo Santos-Ferreira; Fábio Sousa Nunes; Rafael Silva-Teixeira; Marta Leite; Ana Inês Neves; Ricardo Fontes-Carvalho

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Background: </strong>&nbsp;Cardiac amyloidosis is increasingly recognized as a cause of heart failure (HF), although it remains underdiagnosed. Since 2021, according to&nbsp;</span></span></span>Garcia-Pavia, Pablo et al.,<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> screening is recommended for patients with clinical red flags and left ventricular wall thickness (LVT) &ge;12mm. One of the clinical red flags is aortic stenosis in patients older than 65. Thus, it is expected that some TAVI patients fulfill these&nbsp;screening criteria.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aims</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To unveil how many patients undergoing TAVI at our center fulfilled the screening criteria for amyloidosis, and to compare their characteristics against patients not eligible for screening. To evaluate the influence of a higher degree of LVT (defined as LVT&ge;16mm) in patients fulfilling screening criteria&nbsp;compared to those not eligible.&nbsp;&nbsp;&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We evaluated all patients submitted to TAVI in our center from 2007 to 2021. Only patients followed at our center were included. We evaluated patient&#39;s baseline characteristics, LVT, amyloidosis red flags, and the presence of screening criteria. Relevant outcomes were death due to all causes, CV death, HF NYHA, atrial fibrillation (AF) or auricular flutter diagnosis, pacemaker implantation, Acute Coronary Syndrome, Stroke, hospitalization, hospitalization due to HF, emergency department (ED) visit, ED visit due to HF, evaluated at 1-, 3-, 5-year and at the end of the study follow-up.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">260 patients were included, of which 77% (n=200) met the criteria for cardiac amyloidosis screening. Only 1 patient was screened, although results were not yet available. Sixteen percent (n=15) of patients in the screening group reported the development of AF/Flutter at the 5-year follow-up, while it only occurred in 14% (n=3) of the non-screening group (p=0.045). There were no differences in all-cause mortality (HR: 1.03; CI [0.64- 1.66] p&gt;0.9) according to screening eligibility;&nbsp;or other outcomes.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Comparing patients without screening criteria and patients with screening criteria and LVT&ge; 16 mm (n=27), we found that the need to go to the ED (1 or more times) reported at the 1-year follow-up was higher in patients with screening criteria and LVT&ge; 16mm (81%, n=21) compared to those without screening criteria (57%, n= 33, p = 0.035). There were no differences in all-cause mortality (HR:1.41; CI [0.72 - 2.76] p=0.3) according to the screening eligibility and LVT&ge; 16mm;&nbsp;or other outcomes.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Cardiac amyloidosis remains underdiagnosed, corroborated by the low screening rate in our sample. However, applying the newest screening criteria may be challenging, as screening rates may drastically increase. We did not find differences in the clinical profiles of patients with screening criteria or a prognostic value of such criteria in our population, even when a higher degree of LVT is present. Further research is needed to explore who benefits from amyloidosis screening.&nbsp;</span></span></span></p>