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Shiri I, Balzer S, Baj G, Bernhard B, Hundertmark M, Bakula A, Nakase M, Tomii D, Barbati G, Dobner S, Valenzuela W, Rominger A, Caobelli F, Siontis GCM, Lanz J, Pilgrim T, Windecker S, Stortecky S, Gräni C. Multi-modality artificial intelligence-based transthyretin amyloid cardiomyopathy detection in patients with severe aortic stenosis. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06922-4. [PMID: 39307861 DOI: 10.1007/s00259-024-06922-4] [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: 06/04/2024] [Accepted: 09/14/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE Transthyretin amyloid cardiomyopathy (ATTR-CM) is a frequent concomitant condition in patients with severe aortic stenosis (AS), yet it often remains undetected. This study aims to comprehensively evaluate artificial intelligence-based models developed based on preprocedural and routinely collected data to detect ATTR-CM in patients with severe AS planned for transcatheter aortic valve implantation (TAVI). METHODS In this prospective, single-center study, consecutive patients with AS were screened with [99mTc]-3,3-diphosphono-1,2-propanodicarboxylic acid ([99mTc]-DPD) for the presence of ATTR-CM. Clinical, laboratory, electrocardiogram, echocardiography, invasive measurements, 4-dimensional cardiac CT (4D-CCT) strain data, and CT-radiomic features were used for machine learning modeling of ATTR-CM detection and for outcome prediction. Feature selection and classifier algorithms were applied in single- and multi-modality classification scenarios. We split the dataset into training (70%) and testing (30%) samples. Performance was assessed using various metrics across 100 random seeds. RESULTS Out of 263 patients with severe AS (57% males, age 83 ± 4.6years) enrolled, ATTR-CM was confirmed in 27 (10.3%). The lowest performances for detection of concomitant ATTR-CM were observed in invasive measurements and ECG data with area under the curve (AUC) < 0.68. Individual clinical, laboratory, interventional imaging, and CT-radiomics-based features showed moderate performances (AUC 0.70-0.76, sensitivity 0.79-0.82, specificity 0.63-0.72), echocardiography demonstrated good performance (AUC 0.79, sensitivity 0.80, specificity 0.78), and 4D-CT-strain showed the highest performance (AUC 0.85, sensitivity 0.90, specificity 0.74). The multi-modality model (AUC 0.84, sensitivity 0.87, specificity 0.76) did not outperform the model performance based on 4D-CT-strain only data (p-value > 0.05). The multi-modality model adequately discriminated low and high-risk individuals for all-cause mortality at a mean follow-up of 13 months. CONCLUSION Artificial intelligence-based models using collected pre-TAVI evaluation data can effectively detect ATTR-CM in patients with severe AS, offering an alternative diagnostic strategy to scintigraphy and myocardial biopsy.
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Affiliation(s)
- Isaac Shiri
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Sebastian Balzer
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Giovanni Baj
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Benedikt Bernhard
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Moritz Hundertmark
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Adam Bakula
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Masaaki Nakase
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Stephan Dobner
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Waldo Valenzuela
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico Caobelli
- Department of Nuclear Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, Bern, CH - 3010, Switzerland.
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Tsuruda T, Nakada H, Yamamura Y, Matsuura Y, Ogata M, Tanaka M, Suiko Y, Komaki S, Tanaka H, Moribayashi K, Ideguchi T, Terada T, Ota T, Yamamoto K, Nishihira K, Shibata Y, Kaikita K. Basal inferoseptal segment is highly susceptible to deformation in the clinical spectrum of transthyretin-derived amyloid cardiomyopathy. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae076. [PMID: 39286751 PMCID: PMC11404357 DOI: 10.1093/ehjopen/oeae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/24/2024] [Accepted: 08/27/2024] [Indexed: 09/19/2024]
Abstract
Aims While the prevalence of transthyretin-derived amyloid cardiomyopathy (ATTR-CM) is on the rise, detailed understanding of its morphological and functional characteristics within the left ventricle (LV) across heart failure (HF) remains limited. Methods and results Utilizing two-dimensional (2D) speckle-tracking echocardiography, we assessed longitudinal strain (LS) in 63 histology-confirmed ATTR-CM patients. Additionally, cardiac magnetic resonance (CMR) images measured native T1 and extracellular volume (ECV), compared with LS across 18 LV segments. Patients were categorized into three groups based on HF status: Group 1 (no HF symptoms), Group 2 (HF with preserved LV ejection fraction), and Group 3 (HF with reduced LV ejection fraction). LS analysis unveiled susceptibility to deformation in the basal inferoseptal segment, persisting even in asymptomatic cases. CMR demonstrated increasing native T1 deviation, particularly evident in segments distant from the inferoseptal region. Contrastingly, maximal ECV was consistently observed in the basal and mid-ventricular inferior-septum, even in asymptomatic individuals. Segmental LS decline correlated with ECV expansion but not with native T1 values. Conclusion Our findings suggest that the inferoseptal segment is highly susceptible to amyloid infiltration, and 2D speckle-tracking echocardiography and CMR may serve as a valuable tool for its early detection.
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Affiliation(s)
- Toshihiro Tsuruda
- Cardiorenal Research Laboratory, Department of Hemo-Vascular Advanced Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Hiroshi Nakada
- Department of Radiology, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Yoshimasa Yamamura
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Yunosuke Matsuura
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Miyuki Ogata
- Heart Center, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Miyo Tanaka
- Heart Center, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Yosuke Suiko
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Soichi Komaki
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Hiroki Tanaka
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Kohei Moribayashi
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Takeshi Ideguchi
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Tamasa Terada
- Department of Radiology, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Tomomi Ota
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Keisuke Yamamoto
- Department of Cardiology, Miyazaki Medical Association Hospital, 1173, Arita, Miyazaki 880-2102, Japan
| | - Kensaku Nishihira
- Department of Cardiology, Miyazaki Medical Association Hospital, 1173, Arita, Miyazaki 880-2102, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, 1173, Arita, Miyazaki 880-2102, Japan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
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Volpentesta E, Kharoubi M, Donadio C, Rebiai K, Fanen P, Funalot B, Gendre T, Audard V, Canoui-Poitrine F, Itti E, Teiger E, Planté-Bordeneuve V, Oghina S, Tixier D, Mallet S, Broussier A, Damy T, Zaroui A. Phenotype and prognostic factors in geriatric and non-geriatric patients with transthyretin cardiomyopathy. ESC Heart Fail 2024. [PMID: 39021317 DOI: 10.1002/ehf2.14793] [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: 06/21/2023] [Revised: 12/07/2023] [Accepted: 03/21/2024] [Indexed: 07/20/2024] Open
Abstract
AIMS Transthyretin cardiac amyloidosis (ATTR-CM) may be an underestimated cause of heart failure among geriatric patients and represent a unique phenotype and prognostic profile. METHODS AND RESULTS This retrospective, observational, cohort study characterizes cardiac and extracardiac disorders at diagnosis and assesses prognosis among ATTR-CM patients based on age (geriatric vs. non-geriatric) and amyloidosis subtype (wild type, ATTRwt and hereditary, ATTRv). In total, 943 patients with ATTR-CM were included, of which 306 had ATTRv and 637 had ATTRwt. Among these, 331 (35.1%) were non-geriatric (<75 years), and 612 (64.9%) were geriatric (≥75 years). The population exhibited conduction abnormalities, atrial fibrillation and ischaemic heart disease that progressively deteriorated with age. Among ATTRwt patients, peripheral neuropathy, neurovegetative symptoms, and hearing loss were present across all age groups, but reports of carpal tunnel symptoms or surgery decreased with age. Conversely, among ATTRv patients, reports of extracardiac symptoms increased with age and Val122ILe mutation was highly prevalent among geriatric patients. The 3-year survival was higher among non-geriatric ATTR-CM patients (76%) than geriatric patients (55%) and predictors of 3-year mortality differed. Notably, predictors identified among geriatric patients were alkaline phosphatase (ALP) (HR = 1.004, 95% CI: [0.001-1.100)], troponin T hs (HR = 1.005, 95% CI: [1.001-1.120)] and tricuspid insufficiency (HR = 1.194, 95% CI: [1.02-1.230)]. Whereas, among non-geriatric patients, NT-proBNP (HR = 1.002, 95% CI: [1.02-1.04], global longitudinal strain (HR = 0.95, 95% CI: [0.922-0.989], and glomerular filtration rate (HR = 0.984, 95% CI: [0.968-1.00) were identified. We propose a 3-stage prognostic staging system combining troponin T hs (≥44 ng/L) and ALP levels (≥119 UI/L). In the geriatric population, this model discriminated survival more precisely than the National Amyloidosis Centre staging, particularly for classifying between stage 1 (82%), stage 2 (50%) and stage 3 (32%) for ATTRv and ATTRwt. CONCLUSIONS These diagnostic and prognostic indicators, along with ATTR subtype, highlight the distinct characteristics of this important, geriatric ATTR-CM patient group. Recognizing these mortality markers can be valuable for geriatricians to improve the prognostic quality management of geriatric patients with ATTR-CM.
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Affiliation(s)
- Eugenia Volpentesta
- Departement of Geriatrics, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri-Mondor/Albert-Chenevier Hospital, Créteil, France
- Departement of Geriatrics, AP-HP (Assistance Publique-Hôpitaux de Paris), Charles Foix Hospital, Ivry-sur-seine, France
| | - Mounira Kharoubi
- Department of Cardiology, AP-HP (Assistance Publique-Hôpitaux de Paris), DMU Care, Henri Mondor University Hospital, Créteil, France
- Cardiac Amyloidosis Referral Centre, Cardiogen Network, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- GRC Amyloid Research Institute, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- DHU A-TVB, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Cristiano Donadio
- Departement of Geriatrics, AP-HP (Assistance Publique-Hôpitaux de Paris), Charles Foix Hospital, Ivry-sur-seine, France
| | - Kahina Rebiai
- Department of Cardiology, AP-HP (Assistance Publique-Hôpitaux de Paris), DMU Care, Henri Mondor University Hospital, Créteil, France
- Cardiac Amyloidosis Referral Centre, Cardiogen Network, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Pascale Fanen
- Department of Genetics, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- GRC Amyloid Research Institute, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- Department of Genetics, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Thierry Gendre
- Department of Neurology, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France
| | - Vincent Audard
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France
- Department of Nephrology and Renal Transplantation, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Florence Canoui-Poitrine
- DHU A-TVB, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Créteil, France
- Department of Public Health Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Itti
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France
- Department of Nuclear Medicine, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- Clinical Investigation Center 1430, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Teiger
- Department of Cardiology, AP-HP (Assistance Publique-Hôpitaux de Paris), DMU Care, Henri Mondor University Hospital, Créteil, France
- Cardiac Amyloidosis Referral Centre, Cardiogen Network, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- GRC Amyloid Research Institute, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- DHU A-TVB, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Violaine Planté-Bordeneuve
- Department of Neurology, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France
| | - Silvia Oghina
- Department of Cardiology, AP-HP (Assistance Publique-Hôpitaux de Paris), DMU Care, Henri Mondor University Hospital, Créteil, France
- Cardiac Amyloidosis Referral Centre, Cardiogen Network, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Denis Tixier
- Department of Cardiology, AP-HP (Assistance Publique-Hôpitaux de Paris), DMU Care, Henri Mondor University Hospital, Créteil, France
- Cardiac Amyloidosis Referral Centre, Cardiogen Network, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Sophie Mallet
- Department of Cardiology, AP-HP (Assistance Publique-Hôpitaux de Paris), DMU Care, Henri Mondor University Hospital, Créteil, France
- Cardiac Amyloidosis Referral Centre, Cardiogen Network, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Amaury Broussier
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Créteil, France
- Department of Geriatrics, AP-HP, Hopitaux Henri-Mondor/Emile Roux, Limeil-Brevannes, France
| | - Thibaud Damy
- Department of Cardiology, AP-HP (Assistance Publique-Hôpitaux de Paris), DMU Care, Henri Mondor University Hospital, Créteil, France
- Cardiac Amyloidosis Referral Centre, Cardiogen Network, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- GRC Amyloid Research Institute, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- DHU A-TVB, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Créteil, France
| | - Amira Zaroui
- Department of Cardiology, AP-HP (Assistance Publique-Hôpitaux de Paris), DMU Care, Henri Mondor University Hospital, Créteil, France
- Cardiac Amyloidosis Referral Centre, Cardiogen Network, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- GRC Amyloid Research Institute, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- DHU A-TVB, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Créteil, France
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4
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Pereyra Pietri M, Farina JM, Mahmoud AK, Scalia IG, Galasso F, Killian ME, Suppah M, Kenyon CR, Koepke LM, Padang R, Chao CJ, Sweeney JP, Fortuin FD, Eleid MF, Sell-Dottin KA, Steidley DE, Scott LR, Fonseca R, Lopez-Jimenez F, Attia ZI, Dispenzieri A, Grogan M, Rosenthal JL, Arsanjani R, Ayoub C. The prognostic value of artificial intelligence to predict cardiac amyloidosis in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:295-302. [PMID: 38774378 PMCID: PMC11104461 DOI: 10.1093/ehjdh/ztae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 05/24/2024]
Abstract
Aims Cardiac amyloidosis (CA) is common in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Cardiac amyloidosis has poor outcomes, and its assessment in all TAVR patients is costly and challenging. Electrocardiogram (ECG) artificial intelligence (AI) algorithms that screen for CA may be useful to identify at-risk patients. Methods and results In this retrospective analysis of our institutional National Cardiovascular Disease Registry (NCDR)-TAVR database, patients undergoing TAVR between January 2012 and December 2018 were included. Pre-TAVR CA probability was analysed by an ECG AI predictive model, with >50% risk defined as high probability for CA. Univariable and propensity score covariate adjustment analyses using Cox regression were performed to compare clinical outcomes between patients with high CA probability vs. those with low probability at 1-year follow-up after TAVR. Of 1426 patients who underwent TAVR (mean age 81.0 ± 8.5 years, 57.6% male), 349 (24.4%) had high CA probability on pre-procedure ECG. Only 17 (1.2%) had a clinical diagnosis of CA. After multivariable adjustment, high probability of CA by ECG AI algorithm was significantly associated with increased all-cause mortality [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.01-1.96, P = 0.046] and higher rates of major adverse cardiovascular events (transient ischaemic attack (TIA)/stroke, myocardial infarction, and heart failure hospitalizations] (HR 1.36, 95% CI 1.01-1.82, P = 0.041), driven primarily by heart failure hospitalizations (HR 1.58, 95% CI 1.13-2.20, P = 0.008) at 1-year follow-up. There were no significant differences in TIA/stroke or myocardial infarction. Conclusion Artificial intelligence applied to pre-TAVR ECGs identifies a subgroup at higher risk of clinical events. These targeted patients may benefit from further diagnostic evaluation for CA.
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Affiliation(s)
- Milagros Pereyra Pietri
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Juan M Farina
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Ahmed K Mahmoud
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Isabel G Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Francesca Galasso
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Michael E Killian
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Courtney R Kenyon
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Laura M Koepke
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - John P Sweeney
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - F David Fortuin
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - David E Steidley
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Luis R Scott
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Rafael Fonseca
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | | | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Grogan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Julie L Rosenthal
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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5
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Decotto S, Corna G, Villanueva E, Arenaza DPD, Seropian I, Falconi M, Oberti P, Aguirre MA, Posadas-Martínez ML, Carretero M, Agatiello CR, Pizarro R. Prevalence of moderate-severe aortic stenosis in patients with cardiac amyloidosis in a referral center. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:71-78. [PMID: 38507302 PMCID: PMC11160519 DOI: 10.24875/acm.22000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Aortic stenosis (AS) is currently the most common valvular disease, with an estimated prevalence of over 4% in octogenarians. OBJECTIVE To describe the prevalence of moderate-severe aortic stenosis (AS) in patients with wild type transthyretin amyloidosis (ATTRwt). Also, describe the clinical features, echocardiographic characteristics and clinical evolution. METHOD Retrospective cohort of patients with diagnosis of ATTRwt, belonging to Hospital Italiano de Buenos Aires Institutional Amyloidosis Registry, from 30/11/2007 to 31/05/2021. Patients follow up was carried out through the institution clinical history. The prevalence of moderate-severe AE was estimated and presented as a percentage with its 95% confidence interval (95% CI). The characteristics were compared by groups according to whether or not they had moderate-severe AS. RESULTS 104 patients with ATTRwt were included. Median follow up was 476 days [interquartile range: 192-749]. Moderate-severe AS prevalence at the ATTRwt time of diagnosis was 10.5% (n = 11; 95% CI: 5-18%). The median age of patients with AS moderate-severe at the time of diagnosis of ATTRwt was 86 years [78-91] and the male sex predominated (82%). Most of the patients had a history of heart failure (n = 8) and atrial fibrillation (n = 8) prior to the diagnosis of ATTRwt. Most of the patients were subclassified as low flow low gradient severe AS group (n = 7). Four patients underwent some intervention on the aortic valve. During follow-up, 5 patients (46%) were hospitalized for decompensated heart failure and 4 (36%) died. CONCLUSIONS In our cohort, the coexistence of both pathologies had a similar prevalence as reported in the international literature. It was an elderly population with a high percentage of atrial fibrillation and history of heart failure. Most of the patients presented with severe AS with low flow low gradient.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ma. Lourdes Posadas-Martínez
- Instituto de Medicina Traslacional e Ingeniería Biomédica. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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6
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Tavakoli S, Onder O. Four-dimensional Cardiac CT Depicts Coexistent Amyloidosis in Older Adults with Severe Aortic Stenosis. Radiology 2023; 309:e233091. [PMID: 38085085 PMCID: PMC10746845 DOI: 10.1148/radiol.233091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Sina Tavakoli
- From the Departments of Radiology (S.T., O.O.) and Medicine (S.T.), University of Pittsburgh, Pittsburgh, Pa; Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa (S.T.); and Department of Radiology, UPMC Presbyterian Hospital, 200 Lothrop St, Suite E200, Pittsburgh, PA 15213 (S.T.)
| | - Omer Onder
- From the Departments of Radiology (S.T., O.O.) and Medicine (S.T.), University of Pittsburgh, Pittsburgh, Pa; Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa (S.T.); and Department of Radiology, UPMC Presbyterian Hospital, 200 Lothrop St, Suite E200, Pittsburgh, PA 15213 (S.T.)
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7
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Bernhard B, Leib Z, Dobner S, Demirel C, Caobelli F, Rominger A, Schütze J, Grogg H, Alwan L, Spano G, Boscolo Berto M, Lanz J, Pilgrim T, Windecker S, Stortecky S, Gräni C. Routine 4D Cardiac CT to Identify Concomitant Transthyretin Amyloid Cardiomyopathy in Older Adults with Severe Aortic Stenosis. Radiology 2023; 309:e230425. [PMID: 38085082 DOI: 10.1148/radiol.230425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Transthyretin amyloid cardiomyopathy (ATTR-CM) often coexists with severe aortic stenosis (AS). Although strain analysis from cardiac MRI and echocardiography was demonstrated to predict coexisting ATTR-CM, comparable data from four-dimensional (4D) cardiac CT are lacking despite wide availability. Purpose To evaluate the diagnostic performance of 4D cardiac CT-derived parameters in identifying ATTR-CM in older adults considered for transcatheter aortic valve implantation (TAVI). Materials and Methods This prospective single-center screening study for ATTR-CM included consecutive patients with severe AS considered for TAVI who underwent 4D cardiac CT between August 2019 and August 2021 approximately 1 day before technetium 99m (99mTc) 3,3-diphosphono-1,2-propanodicarboxylic-acid (DPD) scintigraphy. The diagnostic performance of CT-based left ventricular (LV), right ventricular, and left atrial dimensions, ejection fraction (EF), and myocardial strain were evaluated against 99mTc-DPD scintigraphy as the reference standard to identify ATTR-CM. Predictors and an unweighted cardiac CT score were validated with internal bootstrapping. The assignment of variables to the score was based on cutoff values achieving the highest Youden index J. Results Among 263 participants (mean age, 83 years ± 4.6 [SD]; 149 male and 114 female participants), 99mTc-DPD scintigraphy (Perugini grade 2 or 3) confirmed coexisting ATTR-CM in 27 (10.3%). CT-derived LV mass index, LV and LA global longitudinal strain (GLS), and relative apical longitudinal strain each predicted the presence of ATTR-CM with an area under the curve (AUC) of at least 0.70. Implementing these parameters with cutoff values of 81 g/m2 or higher, -14.9% or higher, less than 11.5%, and 1.7 or higher in the CT score, respectively, yielded high diagnostic performance (AUC = 0.89; 95% CI: 0.81, 0.94; P < .001) robust to internal bootstrapping validation (AUC = 0.88; 95% CI: 0.82, 0.94). If two criteria were fulfilled, the sensitivity and specificity in the detection of ATTR-CM were 96.3% (95% CI: 81.0, 99.9) and 58.9% (95% CI: 52.3, 65.2), respectively. Conclusion When compared against 99mTc-DPD scintigraphy as the reference standard, routine 4D cardiac CT in older adults considered for TAVI provided high diagnostic performance in the detection of concomitant ATTR-CM by assessing LV and left atrial GLS, relative apical longitudinal strain, and LV mass index. ClinicalTrials.gov registration no.: NCT04061213 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Tavakoli and Onder in this issue.
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Affiliation(s)
- Benedikt Bernhard
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Zoe Leib
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stephan Dobner
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Caglayan Demirel
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Federico Caobelli
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Axel Rominger
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Jonathan Schütze
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Hanna Grogg
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Louhai Alwan
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Giancarlo Spano
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Martina Boscolo Berto
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Jonas Lanz
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Thomas Pilgrim
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stephan Windecker
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stefan Stortecky
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Christoph Gräni
- From the Departments of Cardiology (B.B., Z.L., S.D., C.D., J.S., H.G., L.A., G.S., M.B.B., J.L., T.P., S.W., S.S., C.G.) and Nuclear Medicine (F.C., A.R.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
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8
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Jaiswal V, Agrawal V, Khulbe Y, Hanif M, Huang H, Hameed M, Shrestha AB, Perone F, Parikh C, Gomez SI, Paudel K, Zacks J, Grubb KJ, De Rosa S, Gimelli A. Cardiac amyloidosis and aortic stenosis: a state-of-the-art review. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead106. [PMID: 37941729 PMCID: PMC10630099 DOI: 10.1093/ehjopen/oead106] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
Cardiac amyloidosis is caused by the extracellular deposition of amyloid fibrils in the heart, involving not only the myocardium but also any cardiovascular structure. Indeed, this progressive infiltrative disease also involves the cardiac valves and, specifically, shows a high prevalence with aortic stenosis. Misfolded protein infiltration in the aortic valve leads to tissue damage resulting in the onset or worsening of valve stenosis. Transthyretin cardiac amyloidosis and aortic stenosis coexist in patients > 65 years in about 4-16% of cases, especially in those undergoing transcatheter aortic valve replacement. Diagnostic workup for cardiac amyloidosis in patients with aortic stenosis is based on a multi-parametric approach considering clinical assessment, electrocardiogram, haematologic tests, basic and advanced echocardiography, cardiac magnetic resonance, and technetium labelled cardiac scintigraphy like technetium-99 m (99mTc)-pyrophosphate, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, and 99mTc-hydroxymethylene diphosphonate. However, a biopsy is the traditional gold standard for diagnosis. The prognosis of patients with coexisting cardiac amyloidosis and aortic stenosis is still under evaluation. The combination of these two pathologies worsens the prognosis. Regarding treatment, mortality is reduced in patients with cardiac amyloidosis and severe aortic stenosis after undergoing transcatheter aortic valve replacement. Further studies are needed to confirm these findings and to understand whether the diagnosis of cardiac amyloidosis could affect therapeutic strategies. The aim of this review is to critically expose the current state-of-art regarding the association of cardiac amyloidosis with aortic stenosis, from pathophysiology to treatment.
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Affiliation(s)
- Vikash Jaiswal
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Vibhor Agrawal
- Department of Medicine, King George’s Medical University, Lucknow, India
| | - Yashita Khulbe
- Department of Medicine, King George’s Medical University, Lucknow, India
| | - Muhammad Hanif
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Helen Huang
- University of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maha Hameed
- Department of Internal Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Abhigan Babu Shrestha
- Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic ‘Villa delle Magnolie’,81020 Castel Morrone, Caserta, Italy
| | | | - Sabas Ivan Gomez
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Kusum Paudel
- Department of Medicine, Kathmandu University School of Medical Science, Dhulikhel, Kathmandu 45209, Nepal
| | - Jerome Zacks
- Department of Cardiology, The Icahn Medical School at Mount Sinai, NewYork 10128, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana/CNR Gabriele Monasterio, Pisa 56124, Italy
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9
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Caponetti AG, Accietto A, Saturi G, Ponziani A, Sguazzotti M, Massa P, Giovannetti A, Ditaranto R, Parisi V, Leone O, Guaraldi P, Cortelli P, Gagliardi C, Longhi S, Galiè N, Biagini E. Screening approaches to cardiac amyloidosis in different clinical settings: Current practice and future perspectives. Front Cardiovasc Med 2023; 10:1146725. [PMID: 36970351 PMCID: PMC10033591 DOI: 10.3389/fcvm.2023.1146725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Cardiac amyloidosis is a serious and progressive infiltrative disease caused by the deposition of amyloid fibrils in the heart. In the last years, a significant increase in the diagnosis rate has been observed owing to a greater awareness of its broad clinical presentation. Cardiac amyloidosis is frequently associated to specific clinical and instrumental features, so called "red flags", and it appears to occur more commonly in particular clinical settings such as multidistrict orthopedic conditions, aortic valve stenosis, heart failure with preserved or mildly reduced ejection fraction, arrhythmias, plasma cell disorders. Multimodality approach and new developed techniques such PET fluorine tracers or artificial intelligence may contribute to strike up extensive screening programs for an early recognition of the disease.
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Affiliation(s)
- Angelo Giuseppe Caponetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Antonella Accietto
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giulia Saturi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alberto Ponziani
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Maurizio Sguazzotti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Paolo Massa
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Giovannetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Raffaello Ditaranto
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Vanda Parisi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Ornella Leone
- Department of Pathology, Cardiovascular and Cardiac Transplant Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pietro Guaraldi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pietro Cortelli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Christian Gagliardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologna, Italy
| | - Simone Longhi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Elena Biagini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologna, Italy
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Ferrer-Sistach E, Teis A, Bayés-Genís A, Delgado V. Multimodality imaging in aortic stenosis: new diagnostic and therapeutic frontiers. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:40-46. [PMID: 35716910 DOI: 10.1016/j.rec.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/03/2022] [Indexed: 12/24/2022]
Abstract
The advent of transcatheter aortic valve implantation has revolutionized the treatment of calcific aortic valve stenosis. Elderly patients who were previously considered inoperable have currently an efficacious and safe therapy that provides better survival. In addition, current practice guidelines tend to recommend earlier intervention to avoid the irreversible consequences of long-lasting pressure overload caused by the stenotic aortic valve. Appropriate timing of the intervention relies significantly on imaging techniques that provide information on the severity of the aortic stenosis as well as on the hemodynamic consequences and cardiac remodeling. While left ventricular ejection fraction remains one of the main functional parameters for risk stratification in patients with severe aortic stenosis, advances in imaging techniques have provided new structural and functional parameters that allow the identification of patients who will benefit from intervention before the occurrence of symptoms or irreversible cardiac damage. Furthermore, ongoing research aiming to identify the medical therapies that can effectively halt the progression of aortic stenosis relies heavily on imaging endpoints, and new imaging techniques that characterize the metabolic activity of calcific aortic stenosis have been proposed to monitor the effects of these therapies. The present review provides an up-to-date overview of the imaging advances that characterizes the pathophysiology and that have changed the management paradigm of aortic stenosis.
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Affiliation(s)
| | - Albert Teis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Victoria Delgado
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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11
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Luke P, Alkhalil M, Eggett C. Current and novel echocardiographic assessment of left ventricular systolic function in aortic stenosis-A comprehensive review. Echocardiography 2022; 39:1470-1480. [PMID: 36447299 PMCID: PMC10098594 DOI: 10.1111/echo.15497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/16/2022] [Accepted: 11/06/2022] [Indexed: 12/02/2022] Open
Abstract
Aortic stenosis (AS) is a complex and progressive condition that can significantly reduce the quality of life and increase the incidence of premature mortality. Transthoracic echocardiography (TTE) is the gold standard imaging modality for the assessment of AS severity. While left ventricular ejection fraction (LVEF) derived from TTE is a very well-understood parameter, limitations such as high inter and intra-observer variability, insensitivity to sub-clinical dysfunction, and influence of loading conditions make LVEF a complicated and unreliable parameter. Myocardial deformation imaging has been identified as a promising parameter for identifying subclinical left ventricular dysfunction, however, this parameter is still afterload dependent. Myocardial Work is a promising novel assessment technique that accounts for afterload by combining the use of myocardial deformation imaging and non-invasive blood pressure to provide a more comprehensive assessment of mechanics beyond LVEF. This review evaluates the evidence for various echocardiographic assessment parameters used to quantify left ventricular function including myocardial work in patients with AS.
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Affiliation(s)
- Peter Luke
- School of Biomedical ScienceNutritional and Sport SciencesNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospital TrustFreeman HospitalNewcastle upon TyneUK
| | - Mohammad Alkhalil
- Newcastle upon Tyne Hospital TrustFreeman HospitalNewcastle upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Christopher Eggett
- School of Biomedical ScienceNutritional and Sport SciencesNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospital TrustFreeman HospitalNewcastle upon TyneUK
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12
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Arshad S, Goldberg YH, Bhopalwala H, Dewaswala N, Miceli NS, Birks EJ, Vaidya GN. High Prevalence of Cardiac Amyloidosis in Clinically Significant Aortic Stenosis: A Meta-Analysis. Cardiol Res 2022; 13:357-371. [PMID: 36660066 PMCID: PMC9822671 DOI: 10.14740/cr1436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background There is growing evidence of coexistence of aortic stenosis (AS) and transthyretin cardiac amyloidosis (CA). Not screening AS patients at the time of hospital/clinic visit for CA represents a lost opportunity. Methods We surveyed studies that reported the prevalence of CA among AS patients. Studies that compared patients with aortic stenosis with cardiac amyloidosis (AS-CA) and AS alone were further analyzed, and meta-regression was performed. Results We identified nine studies with 1,321 patients of AS, of which 131 patients had concomitant CA, with a prevalence of 11%. When compared to AS-alone, the patients with AS-CA were older, more likely to be males, had higher prevalence of carpal tunnel syndrome, right bundle branch block. On echocardiogram, patients with AS-CA had thicker interventricular septum, higher left ventricular mass index (LVMI), lower myocardial contraction fraction, and lower stroke volume index. Classical low-flow low-gradient (LFLG) physiology was more common among patients with AS-CA. Patients with AS-CA had higher all-cause mortality than patients with AS alone (33% vs. 22%, P = 0.02) in a follow-up period of at least 1 year. Conclusions CA has a high prevalence in patients with AS and is associated with worse clinical, imaging, and biochemical parameters than patients with AS alone.
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Affiliation(s)
- Samiullah Arshad
- Department of Medicine, University of Kentucky, Lexington, KY, USA,Corresponding Author: Samiullah Arshad, Department of Medicine, University of Kentucky, Lexington, KY, USA.
| | | | - Huzefa Bhopalwala
- Department of Medicine, Appalachian Regional Healthcare, Whitesburg, KY, USA
| | - Nakeya Dewaswala
- Division of Cardiology (Advanced Heart Failure and Transplantation), Gill Heart and Vascular Institute, University of Kentucky, Lexington KY, USA
| | - Nicholas S. Miceli
- College of Management, School of Business, Park University, Parkville, MO, USA
| | - Emma J. Birks
- Division of Cardiology (Advanced Heart Failure and Transplantation), Gill Heart and Vascular Institute, University of Kentucky, Lexington KY, USA
| | - Gaurang N. Vaidya
- Division of Cardiology (Advanced Heart Failure and Transplantation), Gill Heart and Vascular Institute, University of Kentucky, Lexington KY, USA
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13
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Ferrer-Sistach E, Teis A, Bayés-Genís A, Delgado V. Imagen multimodal en la estenosis aórtica: nuevas fronteras diagnósticas y terapéuticas. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
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14
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Singal AK, Singh A, Bansal R, Mishra S. Reply. JACC CardioOncol 2022; 4:144-145. [PMID: 35492829 PMCID: PMC9040100 DOI: 10.1016/j.jaccao.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Sozzi FB, Belmonte M. Role of Cardiac Magnetic Resonance in the Diagnosis of Cardiac Amyloidosis. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1743394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Fabiola B. Sozzi
- Fondazione Ospedale Maggiore Policlinico Cà Granda IRCCS, Milan, Italy
| | - Marta Belmonte
- Fondazione Ospedale Maggiore Policlinico Cà Granda IRCCS, Milan, Italy
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