Unveiling Cardiac Amyloidosis, its Characteristics, and Outcomes Among Patients With MR Undergoing Transcatheter Edge-to-Edge MV Repair
Carolina Donà, Christian Nitsche, Matthias Koschutnik, Gregor Heitzinger, Katharina Mascherbauer, Andreas A Kammerlander, Varius Dannenberg, Kseniya Halavina, René Rettl, Franz Duca, Tatjana Traub-Weidinger, Juergen Puchinger, Petra C Gunacker, Gudrun Lamm, Paul Vock, Brigitte Lileg, Vyhnanek Philipp, Anton Staudenherz, Raffaella Calabretta, Marcus Hacker, Hermine Agis, Philipp Bartko, Christian Hengstenberg, Marianna Fontana, Georg Goliasch, Julia Mascherbauer, Carolina Donà, Christian Nitsche, Matthias Koschutnik, Gregor Heitzinger, Katharina Mascherbauer, Andreas A Kammerlander, Varius Dannenberg, Kseniya Halavina, René Rettl, Franz Duca, Tatjana Traub-Weidinger, Juergen Puchinger, Petra C Gunacker, Gudrun Lamm, Paul Vock, Brigitte Lileg, Vyhnanek Philipp, Anton Staudenherz, Raffaella Calabretta, Marcus Hacker, Hermine Agis, Philipp Bartko, Christian Hengstenberg, Marianna Fontana, Georg Goliasch, Julia Mascherbauer
Abstract
Background: Mitral regurgitation (MR) and cardiac amyloidosis (CA) both primarily affect older patients. Data on coexistence and prognostic implications of MR and CA are currently lacking.
Objectives: This study sought to identify the prevalence, clinical characteristics, and outcomes of MR CA compared with lone MR.
Methods: Consecutive patients undergoing transcatheter edge-to-edge repair (TEER) for MR at 2 sites were screened for concomitant CA using a multiparametric approach including core laboratory 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid bone scintigraphy and echocardiography and immunoglobulin light chain assessment. Transthyretin CA (ATTR) was diagnosed by 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (Perugini grade 1: early infiltration; grades 2/3: clinical CA) and the absence of monoclonal protein, and light chain (AL) CA via tissue biopsy. All-cause mortality and hospitalization for heart failure (HHF) served as the endpoints.
Results: A total of 120 patients (age 76.9 ± 8.1 years, 55.8% male) were recruited. Clinical CA was diagnosed in 14 patients (11.7%; 12 ATTR, 1 AL, and 1 combined ATTR/AL) and early amyloid infiltration in 9 patients (7.5%). Independent predictors of MR CA were increased posterior wall thickness and the presence of a left anterior fascicular block on electrocardiography. Procedural success and periprocedural complications of TEER were similar in MR CA and lone MR (P for all = NS). After a median of 1.7 years, 25.8% had experienced death and/or HHF. MR CA had worse outcomes compared with lone MR (HR: 2.2; 95% CI: 1.0-4.7; P = 0.034), driven by a 2.5-fold higher risk for HHF (HR: 2.5; 95% CI: 1.1-5.9), but comparable mortality (HR: 1.6; 95% CI: 0.4-6.1).
Conclusions: Dual pathology of MR CA is common in elderly patients with MR undergoing TEER and has worse postinterventional outcomes compared with lone MR.
Keywords: cardiac amyloidosis; mitral regurgitation; transcatheter edge-to-edge repair.
Conflict of interest statement
Funding Support and Author Disclosures This study received financial support from Pfizer. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed