Journal article
Outcomes of aortic stenosis in patients with cardiac amyloidosis: A systematic review and meta-analysis
Cardiovascular revascularization medicine, Vol.73, pp.98-106
04/01/2025
DOI: 10.1016/j.carrev.2025.02.005
PMID: 39955158
Abstract
Cardiac amyloidosis (CA) results from the deposition of abnormally folded protein fibrils, leading to restrictive cardiomyopathy, valvular heart disease, and arrhythmias. Up to 15 % of patients with severe aortic stenosis (AS) have concomitant CA (AS-CA). We conducted this systematic review and meta-analysis to compare medical management, transcatheter aortic valve replacement (TAVR), and surgical AVR (SAVR) in AS-CA.
A comprehensive literature search was conducted for relevant studies from inception through January 20, 2024. Studies exploring outcomes in adult AS patients with and without CA receiving medical therapy, TAVR, or SAVR were included in this analysis.
Fifteen studies including 253,334 patients (AS-CA 6704; AS alone 246,630) were identified. AS-CA patients had significantly higher all-cause mortality (RR = 2.60, 95 % CI 1.48–4.57, P = 0.0009) compared to AS alone. Among patients with AS-CA, TAVR was associated with lower all-cause mortality compared to both medical therapy (RR = 0.50, 95 % CI 0.29–0.89, P = 0.02) and SAVR (RR = 0.41, 95 % CI 0.22–0.78, P = 0.007). AS-CA patients undergoing TAVR were more likely to have paradoxical low-flow, low-gradient AS (RR = 1.56, 95 % CI 1.15–2.12, P = 0.04) at baseline and had a higher risk of post-TAVR acute kidney injury (RR = 1.95, 95 % CI 1.35–2.80, P = 0.0003) compared to patients undergoing TAVR for AS alone. There were similar risks of other post-TAVR complications, including major bleeding, vascular complications, stroke, and new pacemaker implantation between AS-CA and AS alone.
CA is associated with a higher mortality in patients with severe AS. In patients with concomitant AS and CA, TAVR is safe and associated with better survival than medical therapy or SAVR.
#Meta-Analysis: Cardiac amyloidosis is associated with increased mortality in severe AS. #TAVR is safe in amyloidosis & improves survival more than medical therapy or SAVR.
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•Cardiac amyloidosis (CA) is a prevalent but frequently underdiagnosed comorbidity in patients with aortic stenosis (AS).•This largest-to-date meta-analysis, encompassing 15 studies and 253,334 patients (6,704 with concomitant AS-CA), confirms that CA is associated with significantly higher all-cause mortality in AS patients.•Transcatheter aortic valve replacement (TAVR) is a safe and effective intervention for AS-CA, reducing mortality compared to medical therapy (RR 0.50) and surgical aortic valve replacement (SAVR) (RR 0.41).
Details
- Title: Subtitle
- Outcomes of aortic stenosis in patients with cardiac amyloidosis: A systematic review and meta-analysis
- Creators
- Soban Ahmad - University of Nebraska Medical CenterMuhammad Junaid Ahsan - Baylor University Medical CenterMorgan Newlun - University of Nebraska Medical CenterMitchell Sand - University of Nebraska Medical CenterAnan Abu Rmilah - Department of Medicine, Magnolia Regional Health Center, Corinth, MS, USAAmman Yousaf - McLaren Regional Medical CenterMuhammad Asim Shabbir - University of Nebraska Medical CenterShahbaz A. Malik - University of Nebraska Medical CenterAndrew M. Goldsweig - University of Nebraska Medical Center
- Resource Type
- Journal article
- Publication Details
- Cardiovascular revascularization medicine, Vol.73, pp.98-106
- DOI
- 10.1016/j.carrev.2025.02.005
- PMID
- 39955158
- NLM abbreviation
- Cardiovasc Revasc Med
- ISSN
- 1553-8389
- eISSN
- 1878-0938
- Publisher
- Elsevier Inc
- Number of pages
- 9
- Language
- English
- Date published
- 04/01/2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984845251902771
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