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Transcatheter aortic valve replacement in patients with coexistent cardiac amyloidosis
Session:
Sessão de Posters 14 - Amiloidose Cardíaca
Speaker:
Vanessa Lopes
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Vanessa Lopes; José Paulo Almeida; Rafaela Fernandes; Gil Cunha; Maria Ferreira; Nádia Moreira; Lino Gonçalves
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Both the prevalence of aortic stenosis (AS) and cardiac amyloidosis (CA) increase with age, which is why their association is not uncommon in the elderly. Outcomes of concomitant AS-CA undergoing transcatheter aortic valve replacement (TAVR) are unknown. This study sought to investigate outcomes of concomitant AS-CA compared with lone AS undergoing TAVR.</span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">We prospectively recruited consecutive patients referred for TAVR in a single center. All patients underwent echocardiography, DPD bone scintigraphy, and blood and urine monoclonal immunoglobulin testing before TAVR. Baseline clinical characteristics, laboratory data, and clinical outcomes were analyzed. The primary endpoint was all-cause mortality.</span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">A total of 60 consecutive AS patients undergoing TAVR were recruited: median age was 83 years (IQR 7), and 55% (n=33) of patients were male. <span style="color:black">DPD scintigraphy</span> was positive in 6 patients (10%; grade 1: 3 patients; grade 2/3: 3 patients). Light-chain CA (AL) was diagnosed in 1 patient with grade 3. </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">AS-CA patients were older [88 (IQR 7) vs. 83 (IQR 6) years; p=0.03], more often male (100% vs. 50%; p=0.03), and more often pacemaker carriers (67% vs. 24%; p=0.048), compared to AS patients without CA. There were no significant differences in the baseline comorbidities and laboratory data among groups. </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Regarding prognosis, after a median follow-up of 26 months post-TAVR, 11.7% of patients died. All-cause follow-up mortality did not differ between the AS-CA and lone AS groups (lone AS 9% vs. AS-CA 33%; HR=3.65, 95% CI 0.71-18.8; p=0.12). None of the patients died during hospitalization. Rehospitalization for heart failure at 30 days did not differ between groups (lose AS 9.3% vs. AS-CA 16.7%, p=0.48). Rates of complications post-TAVR, such as stroke, acute kidney injury, vascular complications, and need for a pacemaker also did not differ between groups.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Concomitant severe AS and CA is common in patients undergoing TAVR. AS-CA survival post-TAVR did not differ from lone AS.</span></span></p>
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