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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| Published in: | Journal of cardiovascular magnetic resonance Vol. 19; no. 1; pp. 98 - 12 |
|---|---|
| Main Authors: | , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
London
Elsevier Inc
07.12.2017
BioMed Central BioMed Central Ltd Elsevier |
| Subjects: | |
| ISSN: | 1097-6647, 1532-429X, 1532-429X |
| Online Access: | Get full text |
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| Abstract | 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 < 0.0001). Adjusting for aortic valve replacement modeled as a time-dependent covariate, Society of Thoracic Surgery predicted risk of mortality, left ventricular ejection fraction, CA remained associated with all-cause mortality (HR = 2.92, 95% CI = 1.09–7.86, P = 0.03).
Suspected CA appears prevalent among older male patients with AS, especially with low flow, low gradient AS, and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation. |
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| AbstractList | Background
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.
Methods
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.
Results
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
< 0.0001). Adjusting for aortic valve replacement modeled as a time-dependent covariate, Society of Thoracic Surgery predicted risk of mortality, left ventricular ejection fraction, CA remained associated with all-cause mortality (HR = 2.92, 95% CI = 1.09–7.86,
P
= 0.03).
Conclusions
Suspected CA appears prevalent among older male patients with AS, especially with low flow, low gradient AS, and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation. 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.BACKGROUNDNon-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.METHODSWe 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 < 0.0001). Adjusting for aortic valve replacement modeled as a time-dependent covariate, Society of Thoracic Surgery predicted risk of mortality, left ventricular ejection fraction, CA remained associated with all-cause mortality (HR = 2.92, 95% CI = 1.09-7.86, P = 0.03).RESULTSThere 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 < 0.0001). Adjusting for aortic valve replacement modeled as a time-dependent covariate, Society of Thoracic Surgery predicted risk of mortality, left ventricular ejection fraction, CA remained associated with all-cause mortality (HR = 2.92, 95% CI = 1.09-7.86, P = 0.03).Suspected CA appears prevalent among older male patients with AS, especially with low flow, low gradient AS, and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation.CONCLUSIONSSuspected CA appears prevalent among older male patients with AS, especially with low flow, low gradient AS, and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation. Background 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. Methods 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. Results 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 < 0.0001). Adjusting for aortic valve replacement modeled as a time-dependent covariate, Society of Thoracic Surgery predicted risk of mortality, left ventricular ejection fraction, CA remained associated with all-cause mortality (HR = 2.92, 95% CI = 1.09-7.86, P = 0.03). Conclusions Suspected CA appears prevalent among older male patients with AS, especially with low flow, low gradient AS, and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation. Keywords: Aortic Stenosis, Cardiac Amyloidosis, Outcomes, Cardiovascular magnetic resonance Abstract Background 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. Methods 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. Results 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 < 0.0001). Adjusting for aortic valve replacement modeled as a time-dependent covariate, Society of Thoracic Surgery predicted risk of mortality, left ventricular ejection fraction, CA remained associated with all-cause mortality (HR = 2.92, 95% CI = 1.09–7.86, P = 0.03). Conclusions Suspected CA appears prevalent among older male patients with AS, especially with low flow, low gradient AS, and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation. 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 < 0.0001). Adjusting for aortic valve replacement modeled as a time-dependent covariate, Society of Thoracic Surgery predicted risk of mortality, left ventricular ejection fraction, CA remained associated with all-cause mortality (HR = 2.92, 95% CI = 1.09–7.86, P = 0.03). Suspected CA appears prevalent among older male patients with AS, especially with low flow, low gradient AS, and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation. 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 < 0.0001). Adjusting for aortic valve replacement modeled as a time-dependent covariate, Society of Thoracic Surgery predicted risk of mortality, left ventricular ejection fraction, CA remained associated with all-cause mortality (HR = 2.92, 95% CI = 1.09-7.86, P = 0.03). Suspected CA appears prevalent among older male patients with AS, especially with low flow, low gradient AS, and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation. |
| ArticleNumber | 98 |
| Audience | Academic |
| Author | Soman, Prem Cavalcante, João L. Schelbert, Erik B. Fridman, Yaron Althouse, Andrew D. Sharbaugh, Michael S. Lee, Joon S. Rijal, Shasank Schindler, John T. Forman, Daniel E. Abdelkarim, Islam Gleason, Thomas G. |
| Author_xml | – sequence: 1 givenname: João L. surname: Cavalcante fullname: Cavalcante, João L. email: cavalcantejl@upmc.edu organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 2 givenname: Shasank surname: Rijal fullname: Rijal, Shasank organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 3 givenname: Islam surname: Abdelkarim fullname: Abdelkarim, Islam organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 4 givenname: Andrew D. surname: Althouse fullname: Althouse, Andrew D. organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 5 givenname: Michael S. surname: Sharbaugh fullname: Sharbaugh, Michael S. organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 6 givenname: Yaron surname: Fridman fullname: Fridman, Yaron organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 7 givenname: Prem surname: Soman fullname: Soman, Prem organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 8 givenname: Daniel E. surname: Forman fullname: Forman, Daniel E. organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 9 givenname: John T. surname: Schindler fullname: Schindler, John T. organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 10 givenname: Thomas G. surname: Gleason fullname: Gleason, Thomas G. organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 11 givenname: Joon S. surname: Lee fullname: Lee, Joon S. organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA – sequence: 12 givenname: Erik B. surname: Schelbert fullname: Schelbert, Erik B. organization: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, 15213, Pittsburgh, PA, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29212513$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
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| Keywords | Aortic Stenosis Cardiovascular magnetic resonance Cardiac Amyloidosis Outcomes |
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| Snippet | Non-invasive cardiac imaging allows detection of cardiac amyloidosis (CA) in patients with aortic stenosis (AS). Our objective was to estimate the prevalence... Background Non-invasive cardiac imaging allows detection of cardiac amyloidosis (CA) in patients with aortic stenosis (AS). Our objective was to estimate the... Background Non-invasive cardiac imaging allows detection of cardiac amyloidosis (CA) in patients with aortic stenosis (AS). Our objective was to estimate the... Abstract Background Non-invasive cardiac imaging allows detection of cardiac amyloidosis (CA) in patients with aortic stenosis (AS). Our objective was to... |
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| SubjectTerms | Age Factors Aged Aged, 80 and over Amyloidosis Amyloidosis - diagnostic imaging Amyloidosis - epidemiology Amyloidosis - mortality Angiology Aortic Stenosis Aortic valve stenosis Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - epidemiology Aortic Valve Stenosis - mortality Aortic Valve Stenosis - surgery Cardiac Amyloidosis Cardiology 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 Imaging Kaplan-Meier Estimate Magnetic Resonance Imaging Male Medicine Medicine & Public Health Middle Aged Mortality Multivariate Analysis Organometallic Compounds - administration & dosage Outcomes Pennsylvania - epidemiology Physiological aspects Prevalence Prognosis Proportional Hazards Models Radiology Rare earth metal compounds Retrospective Studies Risk Factors Severity of Illness Index Sex Factors Time Factors |
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| Title | Cardiac amyloidosis is prevalent in older patients with aortic stenosis and carries worse prognosis |
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