https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Angiologie Tübingen, Deutschland; 2Universitätsklinikum Tübingen Nuklearmedizin Tübingen, Deutschland; 3Universitätsklinikum Tübingen Radiologie Tübingen, Deutschland
BACKGROUND:
If patients with high-grade aortic stenosis become symptomatic and are treated conservatively, they will suffer from rapid progressive heart failure and death within in the next few months. Therefore, these patients should undergo early valve replacement, and are referred for transcatheter aortic valve replacement (TAVR). However, left ventricular hypertrophy and diastolic dysfunction might also occur in patients with cardiac amyloidosis. Wildtype transthyretin (TTR)-related cardiac amyloidosis (ATTR-CA) is also a disorder of ageing individuals and related to an adverse outcome. Therefore, if coexistent, at least some of the adverse events after successful TAVR might rather be related to the presence of cardiac amyloid. 99mTC-3,3-diphosphono-1,2-propanodicarboxylic-acid (DPD) bone scintigraphy is an established non-invasive imaging method to diagnose transthyretin (TTR)-related cardiac amyloidosis (ATTR-CA) with high accuracy by demonstrating increased cardiac uptake.
Aim of our study was to investigate the coexistence of transthyretin cardiac amyloidosis and high-grade aortic stenosis (AS) in a large cohort of elderly AS patients referred for transcatheter aortic valve replacement (TAVR) in a university high-volume center by the use of 99mTC-3,3-diphosphono-1,2-propanodicarboxylic-acid (DPD) bone scintigraphy.
METHODS AND RESULTS:
A total of 234 consecutive patients (mean age 80 ± 7 years, 55% men) with symptomatic severe AS scheduled for TAVR were included and underwent prospectively 99mTC-3,3-diphosphono-1,2-propanodicarboxylic-acid (DPD) bone scintigraphy for evaluation of ATTR-CA. Amyloid was identified in n=16 of 234 patients (prevalence 7%) by demonstrating increased cardiac uptake in the DPD bone scintigraphy.
CONCLUSIONS:
Transthyretin-related cardiac amyloid (ATTR-CA), diagnosed by DPD bone scintigraphy, showed a low coexistence (7%) with high-grade AS in our patients who underwent TAVR. Nevertheless, these patients with coexistent ATTR-CA might benefit from recent medical treatment options and closer monitoring, since ATTR-CA itself portends a poor prognosis.