Abstract 12265: Evaluation of Aortic Valve Calcification in Patients With Suspected Cardiac Amyloidosis

Abstract

Introduction: Cardiac amyloidosis (CA) is characterized by the deposition of misfolded proteins within the heart causing a restrictive cardiomyopathy. Transthyretin (TTR) is one of the most common proteins implicated in CA, as well as in aortic stenosis (AS). The mechanism of TTR-CA associated AS is unclear. Hypothesis: We propose patients with severe AS being evaluated for transcatheter aortic valve replacement (TAVR) and suspected TTR-CA by echocardiogram will have an increased aortic valve calcium score. Secondary outcomes include post-procedural complications. Methods: This was a single-center, retrospective analysis of patients with severe AS referred to the Scripps system for TAVR between January 2017 and November 2022. A total of 496 patients were included and divided into two cohorts. The enriched (Likely CA) cohort consisted of patients with both IVS ≥1.2 cm and average mitral annular systolic s’ ≤ 6 cm/s. The unenriched (Unlikely CA) cohort met only one or none of the above echocardiographic criteria. Results: Of the 496 patients analyzed, 145 patients were in the Likely CA cohort and 351 patients were in the Unlikely CA cohort. Baseline demographics (Table 1A) and echocardiographic data (Table 1B) are shown. There was no statistically significant difference in the primary end point of aortic valve calcium score between the Likely CA and Unlikely CA cohort (p = 0.914). The Likely CA cohort had evidence of worse diastolic function and increased left ventricular dimensions. There was a non-significant trend towards an increased rate of post-procedural atrial fibrillation in the Likely CA cohort (p = 0.051). Otherwise, there was no significant difference in post-procedural complications between the two cohorts (Table 1C). Conclusions: In our analysis of patients with likely TTR-CA and AS compared to those with lone AS, there was no difference in aortic valve calcium score. This suggests aortic valve leaflet calcification is a process independent of TTR-CA.