Concomitant Transthyretin Amyloidosis and Severe Aortic Stenosis in Elderly Indian Population
A. K. Singal, Raghav Bansal, Avinainder Singh, Sharmila Dorbala, Gautam Sharma, Kartik Gupta, Anitá Saxena, Balram Bhargava, Ganesan Karthikeyan, Sivasubramanian Ramakrishnan, Akshay Kumar Bisoi, Milind Hote, Palleti Rajashekar, Ujjwal K. Chowdhury, Velayoudam Devagourou, Chetan B. Patel, Ruma Ray, Sudheer Kumar Arawa, Sundeep Mishra
Abstract
BACKGROUND: Prevalence of both degenerative severe aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CA) increases with age. Dual disease (AS+myocardial ATTR-CA) occurs in significant proportion of patients undergoing surgical aortic valve replacement (SAVR). OBJECTIVES: This study aimed to determine the prevalence of ATTR-CA in severe AS in the Indian population, identify noninvasive predictors of its diagnosis, and understand its impact on prognosis. METHODS: Symptomatic severe AS patients aged ≥65 years undergoing SAVR were enrolled. ATTR-CA diagnosis was based on preoperative 99m-technetium pyrophosphate (PYP) scan and intraoperatively obtained basal interventricular septum biopsy for myocardial ATTR-CA, and excised native aortic valve for isolated valvular ATTR-CA. Primary amyloidosis was excluded by serum/urine protein electrophoresis with serum immunofixation. RESULTS: = 0.477). CONCLUSIONS: Dual disease is not uncommon in India. Isolated valvular amyloidosis in severe AS is much more common.