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Unveiling Cardiac Amyloidosis, its Characteristics, and Outcomes Among Patients With MR Undergoing Transcatheter

Carolina Donà1, Christian Nitsche1, Matthias Koschutnik1

  • 1Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.

JACC. Cardiovascular Interventions
|August 25, 2022
PubMed
Abstract

Insights

Coexisting mitral regurgitation (MR) and cardiac amyloidosis (CA) are common in elderly patients undergoing transcatheter edge-to-edge repair (TEER). This dual pathology leads to worse post-procedural outcomes, particularly increased heart failure hospitalizations, compared to MR alone.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Cardiac Electrophysiology

Background:

  • Mitral regurgitation (MR) and cardiac amyloidosis (CA) are prevalent in elderly populations.
  • Limited data exists on the coexistence and prognostic impact of MR and CA.
  • Understanding this dual pathology is crucial for managing elderly patients with MR.

Purpose of the Study:

  • To determine the prevalence and clinical characteristics of MR with concomitant CA (MR CA).
  • To compare the outcomes of MR CA versus lone MR in patients undergoing TEER.
  • To identify predictors associated with the presence of MR CA.

Main Methods:

  • Consecutive patients undergoing TEER for MR were screened for CA using bone scintigraphy, echocardiography, and immunoglobulin light chain assessment.
  • Transthyretin CA (ATTR) and light chain (AL) CA were diagnosed based on specific criteria.
  • All-cause mortality and hospitalization for heart failure (HHF) were tracked as endpoints.

Main Results:

  • MR CA was diagnosed in 11.7% of patients (12 ATTR, 1 AL, 1 combined ATTR/AL) and early amyloid infiltration in 7.5%.
  • Increased posterior wall thickness and left anterior fascicular block predicted MR CA.
  • MR CA patients had significantly worse outcomes, including a 2.5-fold higher risk of HHF, despite similar TEER procedural success.

Conclusions:

  • The dual pathology of MR and CA is common in elderly patients undergoing TEER for MR.
  • MR CA is associated with significantly worse post-interventional outcomes, primarily driven by increased heart failure hospitalizations.
  • These findings highlight the importance of screening for CA in elderly MR patients undergoing TEER.
Keywords:
cardiac amyloidosismitral regurgitationtranscatheter edge-to-edge repair

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