Dataset Information

Identifying Cardiac Amyloid in Aortic Stenosis: ECV Quantification by CT in TAVR Patients.

ABSTRACT:

Objectives

The purpose of this study was to validate computed tomography measured ECV (ECV_CT) as part of routine evaluation for the detection of cardiac amyloid in patients with aortic stenosis (AS)-amyloid.

Background

AS-amyloid affects 1 in 7 elderly patients referred for transcatheter aortic valve replacement (TAVR). Bone scintigraphy with exclusion of a plasma cell dyscrasia can diagnose transthyretin-related cardiac amyloid noninvasively, for which novel treatments are emerging. Amyloid interstitial expansion increases the myocardial extracellular volume (ECV).

Methods

Patients with severe AS underwent bone scintigraphy (Perugini grade 0, negative; Perugini grades 1 to 3, increasingly positive) and routine TAVR evaluation CT imaging with ECV_CT using 3- and 5-min post-contrast acquisitions. Twenty non-AS control patients also had ECV_CT performed using the 5-min post-contrast acquisition.

Results

A total of 109 patients (43% male; mean age 86 ± 5 years) with severe AS and 20 control subjects were recruited. Sixteen (15%) had AS-amyloid on bone scintigraphy (grade 1, n = 5; grade 2, n = 11). ECV_CT was 32 ± 3%, 34 ± 4%, and 43 ± 6% in Perugini grades 0, 1, and 2, respectively (p < 0.001 for trend) with control subjects lower than lone AS (28 ± 2%; p < 0.001). ECV_CT accuracy for AS-amyloid detection versus lone AS was 0.87 (0.95 for ^99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid Perugini grade 2 only), outperforming conventional electrocardiogram and echocardiography parameters. One composite parameter, the voltage/mass ratio, had utility (similar AUC of 0.87 for any cardiac amyloid detection), although in one-third of patients, this could not be calculated due to bundle branch block or ventricular paced rhythm.

Conclusions

ECV_CT during routine CT TAVR evaluation can reliably detect AS-amyloid, and the measured ECV_CT tracks the degree of infiltration. Another measure of interstitial expansion, the voltage/mass ratio, also performed well.

SUBMITTER: Scully PR

PROVIDER: S-EPMC7536272 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Publications

Identifying Cardiac Amyloid in Aortic Stenosis: ECV Quantification by CT in TAVR Patients.

Scully Paul R PR Patel Kush P KP Saberwal Bunny B Klotz Ernst E Augusto João B JB Thornton George D GD Hughes Rebecca K RK Manisty Charlotte C Lloyd Guy G Newton James D JD Sabharwal Nikant N Kelion Andrew A Kennon Simon S Ozkor Muhiddin M Mullen Michael M Hartman Neil N Cavalcante João L JL Menezes Leon J LJ Hawkins Philip N PN Treibel Thomas A TA Moon James C JC Pugliese Francesca F

JACC. Cardiovascular imaging 20200805 10

<h4>Objectives</h4>The purpose of this study was to validate computed tomography measured ECV (ECV<sub>CT</sub>) as part of routine evaluation for the detection of cardiac amyloid in patients with aortic stenosis (AS)-amyloid.<h4>Background</h4>AS-amyloid affects 1 in 7 elderly patients referred for transcatheter aortic valve replacement (TAVR). Bone scintigraphy with exclusion of a plasma cell dyscrasia can diagnose transthyretin-related cardiac amyloid noninvasively, for which novel treatments ...[more]

PMID: 32771574

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Project description:AimsCardiac amyloidosis is common in elderly patients with aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI). We hypothesized that patients with dual aortic stenosis and cardiac amyloid pathology (AS-amyloid) would have different baseline characteristics, periprocedural and mortality outcomes.Methods and resultsPatients aged ≥75 with severe AS referred for TAVI at two sites underwent blinded bone scintigraphy prior to intervention (Perugini Grade 0 negative, 1-3 increasingly positive). Baseline assessment included echocardiography, electrocardiogram (ECG), blood tests, 6-min walk test, and health questionnaire, with periprocedural complications and mortality follow-up. Two hundred patients were recruited (aged 85 ± 5 years, 50% male). AS-amyloid was found in 26 (13%): 8 Grade 1, 18 Grade 2. AS-amyloid patients were older (88 ± 5 vs. 85 ± 5 years, P = 0.001), with reduced quality of life (EQ-5D-5L 50 vs. 65, P = 0.04). Left ventricular wall thickness was higher (14 mm vs. 13 mm, P = 0.02), ECG voltages lower (Sokolow-Lyon 1.9 ± 0.7 vs. 2.5 ± 0.9 mV, P = 0.03) with lower voltage/mass ratio (0.017 vs. 0.025 mV/g/m2, P = 0.03). High-sensitivity troponin T and N-terminal pro-brain natriuretic peptide were higher (41 vs. 21 ng/L, P < 0.001; 3702 vs. 1254 ng/L, P = 0.001). Gender, comorbidities, 6-min walk distance, AS severity, prevalence of disproportionate hypertrophy, and post-TAVI complication rates (38% vs. 35%, P = 0.82) were the same. At a median follow-up of 19 (10-27) months, there was no mortality difference (P = 0.71). Transcatheter aortic valve implantation significantly improved outcome in the overall population (P < 0.001) and in those with AS-amyloid (P = 0.03).ConclusionsAS-amyloid is common and differs from lone AS. Transcatheter aortic valve implantation significantly improved outcome in AS-amyloid, while periprocedural complications and mortality were similar to lone AS, suggesting that TAVI should not be denied to patients with AS-amyloid.

Dataset Information

Identifying Cardiac Amyloid in Aortic Stenosis: ECV Quantification by CT in TAVR Patients.

Objectives

Background

Methods

Results

Conclusions

Publications

Identifying Cardiac Amyloid in Aortic Stenosis: ECV Quantification by CT in TAVR Patients.

Similar Datasets

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