https://doi.org/10.1007/s00392-025-02625-4
Isabel Mattig (Berlin)1, M. Pollak (Berlin)1, K. Wrede-Wihl (Berlin)2, S. Sökmen (Berlin)1, D. Huscher (Berlin)3, C. Wetz (Berlin)3, B. Heidecker (Berlin)4, G. Barzen (Berlin)5, C. Klein (Berlin)2, A. Unbehaun (Berlin)2, M. A. Sherif (Berlin)2, D. Leistner (Frankfurt am Main)6, S. Sündermann (Berlin)7, A. M. Brand (Berlin)4, S. Spethmann (Berlin)8, G. Hindricks (Berlin)1, H. Dreger (Berlin)2, K. Hahn (Berlin)3, F. Knebel (Berlin)9, D. Messroghli (Berlin)2
1Charité - Universitätsmedizin Berlin
CC11: Med. Klinik m. S. Kardiologie und Angiologie
Berlin, Deutschland; 2Deutsches Herzzentrum der Charite (DHZC)
Klinik für Kardiologie, Angiologie und Intensivmedizin | CBF
Berlin, Deutschland; 3Charité - Universitätsmedizin Berlin
Berlin, Deutschland; 4Charité - Universitätsmedizin Berlin
CC 11: Med. Klinik für Kardiologie
Berlin, Deutschland; 5Charité - Universitätsmedizin Berlin
Medizinische Poliklinik - Kardiologie, Pulmologie u. Angiologie
Berlin, Deutschland; 6Universitätsklinikum Frankfurt
Med. Klinik III - Kardiologie, Angiologie
Frankfurt am Main, Deutschland; 7Charité - Universitätsmedizin Berlin
Klinik für kardiovaskuläre Chirurgie
Berlin, Deutschland; 8Charité - Universitätsmedizin Berlin
Klinik für Kardiologie, Angiologie und Intensivmedizin
Berlin, Deutschland; 9Sana Klinikum Lichtenberg
Klinik für Innere Medizin II, Schwerpunkt Kardiologie
Berlin, Deutschland
Background: Cardiac amyloidosis (CA) is a common comorbidity in patients with severe aortic stenosis (AS) reaching a prevalence of around 8%. As CA involves the left and right ventricle, an assessment of the right heart may be of additional benefit for the diagnosis of CA in AS. The present substudy of the SAVER trial aims to evaluate the diagnostic value of right heart morphology and function to screen for CA in AS patients.
Methods: AS patients, who underwent surgical (SAVR) or transcatheter aortic valve replacement (TAVR) from 2020 to 2023, were enrolled in the SAVER study. In patients with suspected CA, bone scan, MRI, or biopsy were performed to confirm or exclude the diagnosis. A further assessment of the right ventricle (RV) was conducted offline in patients with completed CA diagnostics. Receiver operating characteristic (ROC) analysis was conducted to evaluate the diagnostic value of different RV parameters.
Results: A total of 83 AS patients were enrolled in the current analysis. A bone scan with a Perugini Score of at least one, indicating CA, was observed in 14 patients. These patients had a median age of 82 (95% CI 75-85) years, were male (100%), and mainly underwent TAVR (93%). A negative bone scan, MRI, or endomyocardial biopsy was observed in 69 patients with a median age of 82 (95% CI 77-84) years. 58% of these patients were male and 96% underwent TAVR. Regarding right heart morphology and function, AS patients with suspected CA showed enlarged RV dimensions (RVD) as measured by basal RVD (AS with CA 43±10mm vs. AS 38±8mm, p=0.042), mid RVD (AS with CA 32±8mm vs. AS 27±7mm, p=0.015), and apex-to-base RVD (AS with CA 75 [72-82] mm vs. AS 71 [62-78] mm, p=0.034). Moreover, longitudinal RV free wall strain (RFWS, AS with CA -17±8% vs. AS -22±7%, p=0.032) and RV global strain (RVGS, AS with CA -14 [-18- -10] mm vs. AS -19 [-23- -15] mm, p=0.037) were significantly reduced in AS patients with suspected CA compared to patients with isolated AS. Mid RVD (AUC 0.706 [95% CI 0.549-0.862]), RVFWS (AUC 0.683 [95% CI 0.510-0.855]), and RVGS (AUC 0.700 [95% CI 0.537-0.864]) presented the highest area under the curve to differentiate between AS patients with suspected CA and those without CA.
Conclusion: AS patients with suspected CA showed an enlarged right ventricle with a reduced longitudinal function compared to AS patients without CA. These parameters may be integrated in the echocardiographic assessment of AS patients scheduled for TAVR or SAVR to screen for CA in clinical practice.