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Spielvogel CP, Haberl D, Mascherbauer K, Ning J, Kluge K, Traub-Weidinger T, Davies RH, Pierce I, Patel K, Nakuz T, Göllner A, Amereller D, Starace M, Monaci A, Weber M, Li X, Haug AR, Calabretta R, Ma X, Zhao M, Mascherbauer J, Kammerlander A, Hengstenberg C, Menezes LJ, Sciagra R, Treibel TA, Hacker M, Nitsche C. Diagnosis and prognosis of abnormal cardiac scintigraphy uptake suggestive of cardiac amyloidosis using artificial intelligence: a retrospective, international, multicentre, cross-tracer development and validation study. Lancet Digit Health 2024; 6:e251-e260. [PMID: 38519153 DOI: 10.1016/s2589-7500(23)00265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND The diagnosis of cardiac amyloidosis can be established non-invasively by scintigraphy using bone-avid tracers, but visual assessment is subjective and can lead to misdiagnosis. We aimed to develop and validate an artificial intelligence (AI) system for standardised and reliable screening of cardiac amyloidosis-suggestive uptake and assess its prognostic value, using a multinational database of 99mTc-scintigraphy data across multiple tracers and scanners. METHODS In this retrospective, international, multicentre, cross-tracer development and validation study, 16 241 patients with 19 401 scans were included from nine centres: one hospital in Austria (consecutive recruitment Jan 4, 2010, to Aug 19, 2020), five hospital sites in London, UK (consecutive recruitment Oct 1, 2014, to Sept 29, 2022), two centres in China (selected scans from Jan 1, 2021, to Oct 31, 2022), and one centre in Italy (selected scans from Jan 1, 2011, to May 23, 2023). The dataset included all patients referred to whole-body 99mTc-scintigraphy with an anterior view and all 99mTc-labelled tracers currently used to identify cardiac amyloidosis-suggestive uptake. Exclusion criteria were image acquisition at less than 2 h (99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, 99mTc-hydroxymethylene diphosphonate, and 99mTc-methylene diphosphonate) or less than 1 h (99mTc-pyrophosphate) after tracer injection and if patients' imaging and clinical data could not be linked. Ground truth annotation was derived from centralised core-lab consensus reading of at least three independent experts (CN, TT-W, and JN). An AI system for detection of cardiac amyloidosis-associated high-grade cardiac tracer uptake was developed using data from one centre (Austria) and independently validated in the remaining centres. A multicase, multireader study and a medical algorithmic audit were conducted to assess clinician performance compared with AI and to evaluate and correct failure modes. The system's prognostic value in predicting mortality was tested in the consecutively recruited cohorts using cox proportional hazards models for each cohort individually and for the combined cohorts. FINDINGS The prevalence of cases positive for cardiac amyloidosis-suggestive uptake was 142 (2%) of 9176 patients in the Austrian, 125 (2%) of 6763 patients in the UK, 63 (62%) of 102 patients in the Chinese, and 103 (52%) of 200 patients in the Italian cohorts. In the Austrian cohort, cross-validation performance showed an area under the curve (AUC) of 1·000 (95% CI 1·000-1·000). Independent validation yielded AUCs of 0·997 (0·993-0·999) for the UK, 0·925 (0·871-0·971) for the Chinese, and 1·000 (0·999-1·000) for the Italian cohorts. In the multicase multireader study, five physicians disagreed in 22 (11%) of 200 cases (Fleiss' kappa 0·89), with a mean AUC of 0·946 (95% CI 0·924-0·967), which was inferior to AI (AUC 0·997 [0·991-1·000], p=0·0040). The medical algorithmic audit demonstrated the system's robustness across demographic factors, tracers, scanners, and centres. The AI's predictions were independently prognostic for overall mortality (adjusted hazard ratio 1·44 [95% CI 1·19-1·74], p<0·0001). INTERPRETATION AI-based screening of cardiac amyloidosis-suggestive uptake in patients undergoing scintigraphy was reliable, eliminated inter-rater variability, and portended prognostic value, with potential implications for identification, referral, and management pathways. FUNDING Pfizer.
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Affiliation(s)
- Clemens P Spielvogel
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - David Haberl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Mascherbauer
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Jing Ning
- Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
| | - Kilian Kluge
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Rhodri H Davies
- Institute of Cardiovascular Science, University College London, London, UK; Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Iain Pierce
- Institute of Cardiovascular Science, University College London, London, UK; Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Kush Patel
- Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Thomas Nakuz
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Adelina Göllner
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Amereller
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Starace
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Alice Monaci
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Xiang Li
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander R Haug
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
| | - Raffaella Calabretta
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Xiaowei Ma
- Department of Nuclear Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Min Zhao
- Department of Nuclear Medicine, Third Xiangya Hospital, Central South University, Changsha, China
| | - Julia Mascherbauer
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St Pölten, Krems, Austria
| | - Andreas Kammerlander
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Leon J Menezes
- Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Roberto Sciagra
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, UK; Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Institute of Cardiovascular Science, University College London, London, UK; Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, London, UK.
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2
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Duca F, Kronberger C, Willixhofer R, Bartko PE, Bergler-Klein J, Nitsche C. Cardiac Amyloidosis and Valvular Heart Disease. J Clin Med 2023; 13:221. [PMID: 38202228 PMCID: PMC10779781 DOI: 10.3390/jcm13010221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Growing interest has accrued in the co-existence of cardiac amyloidosis and valvular heart disease. Amyloid infiltration from either transthyretin (ATTR) or of light chain (AL) origin may affect any structure of the heart, including the valves. The recent literature has mainly focused on aortic stenosis and cardiac amyloidosis, improving our understanding of the epidemiology, diagnosis, treatment and prognosis of this dual pathology. Despite being of high clinical relevance, data on mitral/tricuspid regurgitation and cardiac amyloidosis are rather scarce and mostly limited to case reports and small cases series. It is the aim of this review article to summarize the current evidence of concomitant valvular heart disease and cardiac amyloidosis by including studies on epidemiology, diagnostic approaches, screening possibilities, therapeutic management, and prognostic implications.
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Affiliation(s)
| | | | | | | | | | - Christian Nitsche
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (C.K.); (R.W.); (P.E.B.); (J.B.-K.)
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3
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Itzhaki Ben Zadok O, Ruhrman-Sahar N, Mats I, Vaxman I, Shiyovich A, Aviv Y, Vaturi M, Wiessman M, Shochat T, Kandinov I, Kornowski R, Hamdan A. The short and long-term characteristics and outcomes of patients with grade 1 myocardial uptake on cardiac scintigraphy. ESC Heart Fail 2023; 10:1666-1676. [PMID: 36799266 DOI: 10.1002/ehf2.14312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
AIMS This study aimed to characterize the final diagnosis and prognosis of patients with grade 1 myocardial scintigraphy uptake, which is an unequivocal result for the diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) requiring further invasive investigation with tissue biopsy. METHODS AND RESULTS We retrospectively compared the clinical and imaging parameters of patients suspected for ATTR-CA (based on clinical and echocardiographic parameters) with grade 1 vs. grades 2/3 technetium pyrophosphate uptake on cardiac scintigraphy. Prospectively, grade 1 patients underwent re-evaluation for ATTR-CA at long term. Of the 132 ATTR-CA suspected patients, 89 (67%) were diagnosed as grade 1 and 43 (33%) as grades 2/3 uptake. Grade 1 vs. grades 2/3 patients were younger and female predominant with lower biomarker levels and left ventricular mass. Based on available imaging and pathology findings, only 6 out of the 89 patients with grade 1 uptake (7%) were finally diagnosed with light-chain cardiac amyloidosis, whereas no patient was diagnosed with ATTR-CA. At 2 [interquartile range (IQR) 0.75, 3.25] years of follow-up, the survival of patients with grade 1 vs. grades 2/3 uptake was significantly better [hazard ratio 0.271 (95% confidence interval 0.130 to 0.563, P = 0.0005)]. Prospectively, 30 patients with grade 1 uptake were re-evaluated at a median follow-up of 3.2 (IQR 2.2, 3.9) years. Their New York Heart Association class, biomarker levels, and echocardiography findings remained stable. No patient (0/25) demonstrated grades 2/3 uptake at repeated long-term scintigraphy. CONCLUSIONS Patients with suspected ATTR-CA and a grade 1 scintigraphy uptake demonstrate a stable clinical, laboratory, imaging, and scintigraphy phenotype along with a benign survival profile at long-term follow-up. Larger studies should define the optimal evaluation strategy in this population.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Ruhrman-Sahar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Israel Mats
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iuliana Vaxman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Aviv
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordehai Vaturi
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Wiessman
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzippy Shochat
- Research Unit, Rabin Medical Center, Petah Tikva, Israel
| | - Irit Kandinov
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nitsche C. How prevalent is cardiac amyloidosis and which patients should be screened? Eur J Heart Fail 2022; 24:2352-2354. [PMID: 36093633 DOI: 10.1002/ejhf.2685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
- Christian Nitsche
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
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5
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Nitsche C, Mascherbauer K, Calabretta R, Koschutnik M, Dona C, Dannenberg V, Hofer F, Halavina K, Kammerlander AA, Traub-Weidinger T, Goliasch G, Hengstenberg C, Hacker M, Mascherbauer J. Prevalence and Outcomes of Cardiac Amyloidosis in All-Comer Referrals for Bone Scintigraphy. J Nucl Med 2022; 63:1906-1911. [PMID: 35710734 DOI: 10.2967/jnumed.122.264041] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/02/2022] [Indexed: 01/11/2023] Open
Abstract
The prevalence of cardiac amyloidosis (CA) in the general population and associated prognostic implications remain poorly understood. We aimed to identify CA prevalence and outcomes in bone scintigraphy referrals. Methods: Consecutive all-comers undergoing 99mTc-3,3-diphosphono-1,2-propanodicarboxylic-acid (99mTc-DPD) bone scintigraphy between 2010 and 2020 were included. Perugini grade 1 was defined as low-grade uptake and grade 2 or 3 as confirmed CA. All-cause mortality, cardiovascular death, and heart failure hospitalization (HHF) served as endpoints. Results: In total, 17,387 scans from 11,527 subjects (age, 61 ± 16 y; 63.0% women, 73.6% cancer) were analyzed. Prevalence of 99mTc-DPD positivity was 3.3% (n = 376/11,527; grade 1: 1.8%, grade 2 or 3: 1.5%), and was higher among cardiac than noncardiac referrals (18.2% vs. 1.7%). In individuals with more than 1 scan, progression from grade 1 to grade 2 or 3 was observed. Among patients with biopsy-proven CA, the portion of light-chain (AL)-CA was significantly higher in grade 1 than grade 2 or 3 (73.3% vs. 15.4%). After a median of 6 y, clinical event rates were: 29.4% mortality, 2.6% cardiovascular death, and 1.5% HHF, all independently predicted by positive 99mTc-DPD. Overall, adverse outcomes were driven by confirmed CA (vs. grade 0, mortality: adjusted hazard ratio [AHR] 1.46 [95% CI 1.12-1.90]; cardiovascular death: AHR 2.34 [95% CI 1.49-3.68]; HHF: AHR 2.25 [95% CI 1.51-3.37]). One-year mortality was substantially higher in cancer than noncancer patients. Among noncancer patients, also grade 1 had worse outcomes than grade 0 (HHF/death: AHR 1.45 [95% CI 1.01-2.09]), presumably because of longer observation and higher prognostic impact of early infiltration. Conclusion: Positive 99mTc-DPD was identified in a substantial number of consecutive 99mTc-DPD referrals and associated with adverse outcomes.
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Affiliation(s)
- Christian Nitsche
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria;
| | | | - Raffaella Calabretta
- Department of Nuclear Medicine, Medical University of Vienna, Vienna, Austria; and
| | - Matthias Koschutnik
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Carolina Dona
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Varius Dannenberg
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Felix Hofer
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Kseniya Halavina
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | | | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Marcus Hacker
- Department of Nuclear Medicine, Medical University of Vienna, Vienna, Austria; and
| | - Julia Mascherbauer
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
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6
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Donà C, Nitsche C, Koschutnik M, Heitzinger G, Mascherbauer K, Kammerlander AA, Dannenberg V, Halavina K, Rettl R, Duca F, Traub-Weidinger T, Puchinger J, Gunacker PC, Lamm G, Vock P, Lileg B, Philipp V, Staudenherz A, Calabretta R, Hacker M, Agis H, Bartko P, Hengstenberg C, Fontana M, Goliasch G, Mascherbauer J. Unveiling Cardiac Amyloidosis, its Characteristics, and Outcomes Among Patients With MR Undergoing Transcatheter Edge-to-Edge MV Repair. JACC Cardiovasc Interv 2022; 15:1748-1758. [PMID: 36008266 DOI: 10.1016/j.jcin.2022.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 12/19/2022]
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.
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Affiliation(s)
- Carolina Donà
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
| | - Matthias Koschutnik
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gregor Heitzinger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Katharina Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas A Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Varius Dannenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Kseniya Halavina
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Juergen Puchinger
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St Pölten, Krems, Austria
| | - Petra C Gunacker
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St Pölten, Krems, Austria
| | - Gudrun Lamm
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St Pölten, Krems, Austria
| | - Paul Vock
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St Pölten, Krems, Austria
| | - Brigitte Lileg
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St Pölten, Krems, Austria
| | - Vyhnanek Philipp
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St Pölten, Krems, Austria
| | - Anton Staudenherz
- Karl Landsteiner University of Health Sciences, Department of Nuclear Medicine, University Hospital St Pölten, Krems, Austria
| | - Raffaella Calabretta
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Hermine Agis
- Department of Hematology, Medical University of Vienna, Vienna, Austria
| | - Philipp Bartko
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria; Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St Pölten, Krems, Austria
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Elgendy IY, Elbadawi A. Transcatheter Edge-to-Edge Repair of the Mitral Valve Among Patients With Cardiac Amyloidosis. JACC Cardiovasc Interv 2022; 15:1759-1761. [PMID: 36075646 DOI: 10.1016/j.jcin.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 10/15/2022]
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8
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Nitsche C. Echocardiographic tracking of ATTR Cardiomyopathy: which parameters matter the most? Eur J Heart Fail 2022; 24:1713-1715. [PMID: 35906799 DOI: 10.1002/ejhf.2639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Christian Nitsche
- Medical University of Vienna, Division of Cardiology, Waehringerguertel 18-20, 1090, Vienna, Austria
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9
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Nitsche C, Koschutnik M, Donà C, Radun R, Mascherbauer K, Kammerlander A, Heitzinger G, Dannenberg V, Spinka G, Halavina K, Winter MP, Calabretta R, Hacker M, Agis H, Rosenhek R, Bartko P, Hengstenberg C, Treibel T, Mascherbauer J, Goliasch G. Reverse Remodeling Following Valve Replacement in Coexisting Aortic Stenosis and Transthyretin Cardiac Amyloidosis. Circ Cardiovasc Imaging 2022; 15:e014115. [PMID: 35861981 DOI: 10.1161/circimaging.122.014115] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dual pathology of severe aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR) is increasingly recognized. Evolution of symptoms, biomarkers, and myocardial mechanics in AS-ATTR following valve replacement is unknown. We aimed to characterize reverse remodeling in AS-ATTR and compared with lone AS. METHODS Consecutive patients referred for transcatheter aortic valve replacement (TAVR) underwent ATTR screening by blinded 99mTc-DPD bone scintigraphy (Perugini Grade-0 negative, 1-3 increasingly positive) before intervention. ATTR was diagnosed by DPD and absence of monoclonal protein. Reverse remodeling was assessed by comprehensive evaluation before TAVR and at 1 year. RESULTS One hundred twenty patients (81.8±6.3 years, 51.7% male, 95 lone AS, 25 AS-ATTR) with complete follow-up were studied. At 12 months (interquartile range, 7-17) after TAVR, both groups experienced significant symptomatic improvement by New York Heart Association functional class (both P<0.001). Yet, AS-ATTR remained more symptomatic (New York Heart Association ≥III: 36.0% versus 13.8; P=0.01) with higher residual NT-proBNP (N-terminal pro-brain natriuretic peptide) levels (P<0.001). Remodeling by echocardiography showed left ventricular mass regression only for lone AS (P=0.002) but not AS-ATTR (P=0.5). Global longitudinal strains improved similarly in both groups. Conversely, improvement of regional longitudinal strain showed a base-to-apex gradient in AS-ATTR, whereas all but apical segments improved in lone AS. This led to the development of an apical sparing pattern in AS-ATTR only after TAVR. CONCLUSIONS Patterns of reverse remodeling differ from lone AS to AS-ATTR, with both groups experiencing symptomatic improvement by TAVR. After AS treatment, AS-ATTR transfers into a lone ATTR cardiomyopathy phenotype.
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Affiliation(s)
- Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Matthias Koschutnik
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Carolina Donà
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Richard Radun
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Katharina Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Andreas Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Gregor Heitzinger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Varius Dannenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Georg Spinka
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Kseniya Halavina
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Max-Paul Winter
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | | | - Marcus Hacker
- Division of Nuclear Medicine (R.C., M.H.), Medical University of Vienna
| | - Hermine Agis
- Division of Hematology (H.A.), Medical University of Vienna
| | - Raphael Rosenhek
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Philipp Bartko
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
| | - Thomas Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom (T.T.)
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine III, University Hospital St. Pölten, Krems, Austria (J.M.)
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (C.N., M.K., C.D., R. Radun, K.M., A.K., G.H., V.D., G.S., K.H., M.-P.W., R. Rosenhek, P.B., C.H., J.M., G.G.)
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