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Aortic valve intervention for aortic stenosis and cardiac amyloidosis: a systematic review and meta-analysis

Diana de Campos1, Carolina Saleiro1, Ana Botelho1

  • 1Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, Coimbra, 3041-801, Portugal.

Future Cardiology
|April 14, 2022
PubMed

Insights

Cardiac amyloidosis with aortic stenosis (CA-AS) is prevalent in older adults. Aortic valve intervention in CA-AS patients shows comparable mortality risks to aortic stenosis alone, suggesting it is not futile.

Area of Science:

  • Cardiology
  • Geriatrics
  • Cardiac Amyloidosis Research

Background:

  • Aortic stenosis (AS) is a common valvular heart disease, particularly in the elderly.
  • Cardiac amyloidosis (CA) is increasingly recognized as a comorbidity with AS, termed CA-AS.
  • Outcomes for CA-AS patients undergoing aortic valve (AV) intervention require further clarification.

Purpose of the Study:

  • To provide an overview of outcomes following AV intervention in patients with CA-AS.
  • To conduct a meta-analysis to assess the risk of all-cause mortality after AV intervention in CA-AS.
  • To compare outcomes of AV intervention in CA-AS versus AS alone.

Main Methods:

  • Systematic literature review and meta-analysis.
  • Inclusion of studies reporting outcomes after surgical or transcatheter AV replacement in CA-AS patients.
  • Primary endpoint: all-cause mortality.

Main Results:

  • Weighted pooled analysis indicated a non-significant trend towards higher mortality risk in CA-AS patients post-AV replacement (surgical or transcatheter).
  • Specifically, after transcatheter AV replacement, the risk of death in CA-AS patients was comparable to patients with AS alone (RR: 1.23; 95% CI: 0.77-1.96).
  • Low heterogeneity (I² = 0%) was observed in the transcatheter AV replacement group.

Conclusions:

  • Aortic valve intervention may not be futile in patients with cardiac amyloidosis and aortic stenosis.
  • These findings suggest that patients with CA-AS should not be denied AV intervention.
  • Further research may refine risk stratification and management strategies for this complex patient group.

Keywords:
aortic stenosiscardiac amyloidosisclinical outcomessurgical aortic valve replacementtranscatheter aortic valve replacement

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