Cardiac amyloidosis is prevalent in older patients with aortic stenosis and carries worse prognosis

Non-invasive cardiac imaging allows detection of cardiac amyloidosis (CA) in patients with aortic stenosis (AS). Our objective was to estimate the prevalence of clinically suspected CA in patients with moderate and severe AS referred for cardiovascular magnetic resonance (CMR) in age and gender cate...

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Bibliographic Details
Published in:	Journal of cardiovascular magnetic resonance 2017-12, Vol.19 (1), p.98-98, Article 98
Main Authors:	Cavalcante, João L, Rijal, Shasank, Abdelkarim, Islam, Althouse, Andrew D, Sharbaugh, Michael S, Fridman, Yaron, Soman, Prem, Forman, Daniel E, Schindler, John T, Gleason, Thomas G, Lee, Joon S, Schelbert, Erik B
Format:	Article
Language:	eng
Subjects:	Age Factors Aged Aged patients Aged, 80 and over Amyloidosis Amyloidosis - diagnostic imaging Amyloidosis - epidemiology Amyloidosis - mortality Aortic Stenosis Aortic valve stenosis Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - epidemiology Aortic Valve Stenosis - mortality Aortic Valve Stenosis - surgery Cardiac Amyloidosis Cardiomyopathies - diagnostic imaging Cardiomyopathies - epidemiology Cardiomyopathies - mortality Cardiovascular magnetic resonance Chi-Square Distribution Comorbidity Comparative analysis Contrast Media - administration & dosage Echocardiography, Doppler Elderly patients Female Gadolinium - administration & dosage Health aspects Heart Valve Prosthesis Implantation Heterocyclic Compounds - administration & dosage Humans Kaplan-Meier Estimate Magnetic Resonance Imaging Male Middle Aged Mortality Multivariate Analysis Organometallic Compounds - administration & dosage Outcomes Pennsylvania - epidemiology Physiological aspects Prevalence Prognosis Proportional Hazards Models Rare earth metal compounds Retrospective Studies Risk Factors Severity of Illness Index Sex Factors Time Factors
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Summary:	Non-invasive cardiac imaging allows detection of cardiac amyloidosis (CA) in patients with aortic stenosis (AS). Our objective was to estimate the prevalence of clinically suspected CA in patients with moderate and severe AS referred for cardiovascular magnetic resonance (CMR) in age and gender categories, and assess associations between AS-CA and all-cause mortality. We retrospectively identified consecutive AS patients defined by echocardiography referred for further CMR assessment of valvular, myocardial, and aortic disease. CMR identified CA based on typical late-gadolinium enhancement (LGE) patterns, and ancillary clinical evaluation identified suspected CA. Survival analysis with the Log rank test and Cox regression compared associations between CA and mortality. There were 113 patients (median age 74 years, Q1-Q3: 62-82 years), 96 (85%) with severe AS. Suspected CA was present in 9 patients (8%) all > 80 years. Among those over the median age of 74 years, the prevalence of CA was 9/57 (16%), and excluding women, the prevalence was 8/25 (32%). Low-flow, low-gradient physiology was very common in CA (7/9 patients or 78%). Over a median follow-up of 18 months, 40 deaths (35%) occurred. Mortality in AS + CA patients was higher than AS alone (56% vs. 20% at 1-year, log rank 15.0, P
ISSN:	1532-429X 1097-6647 1532-429X