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European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

22.08.2023 | Original Article

Prevalence of ATTR-CA and high-risk features to guide testing in patients referred for TAVR

verfasst von: Bryan Abadie, Adel Hajj Ali, Trejeeve Martyn, Andrew Higgins, Amar Krishnaswamy, Grant Reed, Rishi Puri, James Yun, Paul Cremer, Mazen Hanna, W. H. Wilson Tang, Samir Kapadia, Wael Jaber

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 13/2023

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Abstract

Purpose

Transthyretin cardiac amyloidosis (ATTR-CA) is thought to be prevalent in patients with severe aortic stenosis (AS) who are referred for transcatheter aortic valve replacement (TAVR). However, prior studies were published when TAVR was only offered to elderly, inoperable, and high-risk patients. The aim of this study was to reevaluate the prevalence of ATTR-CA in a contemporary TAVR population and identify high-risk features to guide referral for technetium-99 pyrophosphate scan (99mTc-PyP scan) screening.

Methods

Patients seen in a multidisciplinary TAVR clinic for severe AS 70 years and older were referred for a 99mTc-PyP scan to evaluate for ATTR-CA. The primary outcome was the percent with a positive scan. The discriminatory ability of high-risk features was assessed to develop a more judicious screening system.

Results

Over the study period, 380 patients underwent screening, and 20 patients (5.3%) had a positive scan, with 17 patients having confirmed ATTR-CA, 1 patient deferring confirmatory testing (combined 4.7%), 1 having light chain amyloidosis, and 1 negative on biopsy. Compared to other patient and echocardiographic measures, elevated NT-pro BNP (> 1000 ng/L) was the best discriminator on who should be referred for 99mTc-PyP scan screening, with a sensitivity of 90% and a negative predictive value of 99%.

Conclusion

The prevalence of ATTR-CA may be lower in a contemporary TAVR population due to its expanded indication for low-risk patients. NT-pro BNP is a simple test that can improve screening yield and more judiciously guide screening for ATTR-CA in this at-risk population.

Graphical abstract

Comparison of the original versus the proposed algorithm

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Titel: Prevalence of ATTR-CA and high-risk features to guide testing in patients referred for TAVR
verfasst von: Bryan Abadie
Adel Hajj Ali
Trejeeve Martyn
Andrew Higgins
Amar Krishnaswamy
Grant Reed
Rishi Puri
James Yun
Paul Cremer
Mazen Hanna
W. H. Wilson Tang
Samir Kapadia
Wael Jaber
Publikationsdatum: 22.08.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 13/2023
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-023-06374-2

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Prevalence of ATTR-CA and high-risk features to guide testing in patients referred for TAVR

Abstract

Purpose

Methods

Results

Conclusion

Graphical abstract

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Graphical abstract

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