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High Prevalence of Cardiac Amyloidosis in Clinically Significant Aortic Stenosis: A Meta-Analysis

Samiullah Arshad1, Ythan H Goldberg2, Huzefa Bhopalwala3

  • 1Department of Medicine, University of Kentucky, Lexington, KY, USA.

Cardiology Research
|January 20, 2023
PubMed

Insights

Screening aortic stenosis (AS) patients for transthyretin cardiac amyloidosis (CA) is crucial, as 11% have concomitant CA. Coexisting AS and CA are linked to worse outcomes and distinct clinical, imaging, and mortality profiles.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Medical Diagnostics

Background:

  • Growing evidence highlights the coexistence of aortic stenosis (AS) and transthyretin cardiac amyloidosis (CA).
  • Failure to screen AS patients for CA during clinical encounters represents a missed diagnostic opportunity.

Purpose of the Study:

  • To determine the prevalence of CA in patients with AS.
  • To compare clinical, imaging, and mortality characteristics between patients with AS and concomitant CA (AS-CA) versus AS alone.

Main Methods:

  • A systematic survey of studies reporting CA prevalence in AS patients was conducted.
  • Meta-regression analysis was performed on studies comparing AS-CA patients with AS-alone patients.

Main Results:

  • Nine studies encompassing 1,321 AS patients revealed an 11% prevalence of CA (131 patients).
  • AS-CA patients were older, more male, and exhibited higher rates of carpal tunnel syndrome and right bundle branch block.
  • Echocardiographic findings in AS-CA included thicker interventricular septum, higher LVMI, and reduced myocardial contraction and stroke volume indices, with a higher incidence of low-flow low-gradient AS.

Conclusions:

  • Transthyretin cardiac amyloidosis is highly prevalent in patients with aortic stenosis.
  • AS-CA is associated with significantly worse clinical, imaging, and biochemical parameters compared to AS alone.
  • Patients with AS-CA demonstrated higher all-cause mortality (33% vs. 22%) at one-year follow-up.
Abstract

Keywords:
Aortic stenosisCardiac amyloidosisClinical featuresImaging characteristicsMortalityPrevalence

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