dc.contributor.author | Nitsche, C | |
dc.contributor.author | Scully, PR | |
dc.contributor.author | Patel, KP | |
dc.contributor.author | Kammerlander, AA | |
dc.contributor.author | Koschutnik, M | |
dc.contributor.author | Dona, C | |
dc.contributor.author | Wollenweber, T | |
dc.contributor.author | Ahmed, N | |
dc.contributor.author | Thornton, GD | |
dc.contributor.author | Kelion, AD | |
dc.contributor.author | Sabharwal, N | |
dc.contributor.author | Newton, JD | |
dc.contributor.author | Ozkor, M | |
dc.contributor.author | Kennon, S | |
dc.contributor.author | Mullen, M | |
dc.contributor.author | Lloyd, G | |
dc.contributor.author | Fontana, M | |
dc.contributor.author | Hawkins, PN | |
dc.contributor.author | Pugliese, F | |
dc.contributor.author | Menezes, LJ | |
dc.contributor.author | Moon, JC | |
dc.contributor.author | Mascherbauer, J | |
dc.contributor.author | Treibel, TA | |
dc.date.accessioned | 2021-04-06T14:38:06Z | |
dc.date.available | 2020-11-04 | |
dc.date.available | 2021-04-06T14:38:06Z | |
dc.date.issued | 2021-01-19 | |
dc.identifier.citation | ristian Nitsche, Paul R. Scully, Kush P. Patel, Andreas A. Kammerlander, Matthias Koschutnik, Carolina Dona, Tim Wollenweber, Nida Ahmed, George D. Thornton, Andrew D. Kelion, Nikant Sabharwal, James D. Newton, Muhiddin Ozkor, Simon Kennon, Michael Mullen, Guy Lloyd, Marianna Fontana, Philip N. Hawkins, Francesca Pugliese, Leon J. Menezes, James C. Moon, Julia Mascherbauer, Thomas A. Treibel, Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis, Journal of the American College of Cardiology, Volume 77, Issue 2, 2021, Pages 128-139, https://doi.org/10.1016/j.jacc.2020.11.006. | en_US |
dc.identifier.issn | 0735-1097 | |
dc.identifier.uri | https://qmro.qmul.ac.uk/xmlui/handle/123456789/71083 | |
dc.description.abstract | BACKGROUND: Older patients with severe aortic stenosis (AS) are increasingly identified as having cardiac amyloidosis
(CA). It is unknown whether concomitant AS-CA has worse outcomes or results in futility of transcatheter aortic valve
replacement (TAVR).
OBJECTIVES: This study identified clinical characteristics and outcomes of AS-CA compared with lone AS.
METHODS: Patients who were referred for TAVR at 3 international sites underwent blinded research core laboratory
99mtechnetium-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) bone scintigraphy (Perugini grade 0: negative; grades 1
to 3: increasingly positive) before intervention. Transthyretin-CA (ATTR) was diagnosed by DPD and absence of a clonal
immunoglobulin, and light-chain CA (AL) was diagnosed via tissue biopsy. National registries captured all-cause mortality.
RESULTS: A total of 407 patients (age 83.4 6.5 years; 49.8% men) were recruited. DPD was positive in 48 patients
(11.8%; grade 1: 3.9% [n ¼ 16]; grade 2/3: 7.9% [n ¼ 32]). AL was diagnosed in 1 patient with grade 1. Patients with grade
2/3 had worse functional capacity, biomarkers (N-terminal pro-brain natriuretic peptide and/or high-sensitivity troponin
T), and biventricular remodeling. A clinical score (RAISE) that used left ventricular remodeling (hypertrophy/diastolic
dysfunction), age, injury (high-sensitivity troponin T), systemic involvement, and electrical abnormalities (right bundle
branch block/low voltages) was developed to predict the presence of AS-CA (area under the curve: 0.86; 95% confidence
interval: 0.78 to 0.94; p < 0.001). Decisions by the heart team (DPD-blinded) resulted in TAVR (333 [81.6%]), surgical
AVR (10 [2.5%]), or medical management (65 [15.9%]). After a median of 1.7 years, 23% of patients died. One-year
mortality was worse in all patients with AS-CA (grade: 1 to 3) than those with lone AS (24.5% vs. 13.9%; p ¼ 0.05). TAVR
improved survival versus medical management; AS-CA survival post-TAVR did not differ from lone AS (p ¼ 0.36).
CONCLUSIONS: Concomitant pathology of AS-CA is common in older patients with AS and can be predicted clinically.
AS-CA has worse clinical presentation and a trend toward worse prognosis, unless treated. Therefore, TAVR should not
be withheld in AS-CA. (J Am Coll Cardiol 2021;77:128–39) © 2021 The Authors. Published by Elsevier on behalf of
the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/). | en_US |
dc.format.extent | 128 - 139 | |
dc.relation.ispartof | JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | |
dc.rights | CC BY-NC-ND LICENSE | |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
dc.subject | aortic stenosis | en_US |
dc.subject | cardiac amyloidosis | en_US |
dc.subject | TAVR | en_US |
dc.title | Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis | en_US |
dc.type | Article | en_US |
dc.rights.holder | © 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. | |
dc.identifier.doi | 10.1016/j.jacc.2020.11.006 | |
pubs.author-url | http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000608973900003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=612ae0d773dcbdba3046f6df545e9f6a | en_US |
pubs.issue | 2 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 77 | en_US |
rioxxterms.funder | Default funder | en_US |
rioxxterms.identifier.project | Default project | en_US |