Scoring system stratifies “dual” risk in aortic stenosis patients

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A study published in the Journal of the American College of Cardiology (JACC) has detailed a scoring system that can be used to screen for the dual occurrence of aortic stenosis and cardiac amyloidosis

The study, authored by Christian Nitsche from the Division of Cardiology, Department of Medicine II of MedUni Vienna and Vienna General Hospital, Vienna, Austria looked at the coincidence of both diseases in aortic stenosis patients referred for a transcatheter aortic valve implantation (TAVI) procedure, as well as any prognostic implication.

Aortic stenosis is a common heart valve defects, which increases in prevalence with age. Up until now, it has not clear whether patients with cardiac amyloidosis would also benefit from a valve replacement. In this condition, amyloid protein deposits cause the heart muscle to thicken and harden.

Overall, cardiac amyloidosis was detected in one in eight of the 407 aortic stenosis patients examined. Since it is not economically or logistically feasible to carry out a DPD bone scintigraphy scan on all TAVI patients, the study team developed a scoring system based on simple clinical parameters to screen for dual heart disease.

“The scoring system enables us to use simple clinical parameters such as ECG changes, above-average cardiac hypertrophy or existing or operated carpal tunnel syndrome, to predict the probability of concomitant cardiac amyloidosis in aortic stenosis patients, so that they require further investigation using DPD bone scintigraphy,” says lead investigator Nitsche.

The study also found that both aortic stenosis patients with concomitant cardiac amyloidosis and those without this additional heart disease benefit from TAVI. “The results show that the minimally invasive TAVI technique is suitable for both groups. We therefore conclude that TAVI should not be withheld from aortic stenosis patients who also suffer from cardiac amyloidosis,” says Nitsche.

Further studies are required to determine whether the drugs used to treat cardiac amyloidosis improve survival in dual heart disease on top of aortic valve replacement, the study suggests.


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