November 2021 - Christian Nitsche

Dr. Christian Nitsche

MedUni Wien RESEARCHER OF THE MONTH November 2021

Dual pathology of aortic stenosis (AS) and cardiac amyloidosis (CA) has recently received fast growing attention.  The present study looked at the coincidence of both diseases in AS patients referred for a transcatheter aortic valve replacement (TAVR) procedure, as well as any prognostic implication. CA screening was performed using DPD bone scintigraphy. CA 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 TAVR patients, the study team developed a scoring system based on simple clinical parameters to screen for dual heart disease. Overall, AS-CA patients had increased 1-year mortality compared to lone AS. However, AS-CA who received TAVR performed equally to lone AS. The study team concluded that TAVR should not be withheld from AS patients who also suffer from CA.

Selected Literature

1. Nitsche C, Scully PR, Patel KP, Kammerlander A, Koschutnik M, Dona C, et al. Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis. Journal of the American College of Cardiology. 2020.
2. Treibel TA, Fontana M, Gilbertson JA, Castelletti S, White SK, Scully PR, et al. Occult Transthyretin Cardiac Amyloid in Severe Calcific Aortic Stenosis: Prevalence and Prognosis in Patients Undergoing Surgical Aortic Valve Replacement. Circulation Cardiovascular imaging. 2016;9(8).
3. Nitsche C, Aschauer S, Kammerlander AA, Schneider M, Poschner T, Duca F, et al. Light-chain and transthyretin cardiac amyloidosis in severe aortic stenosis: prevalence, screening possibilities, and outcome. European journal of heart failure. 2020.
4. Scully PR, Patel KP, Treibel TA, Thornton GD, Hughes RK, Chadalavada S, et al. Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation. European heart journal. 2020.
5. Gillmore JD, Maurer MS, Falk RH, Merlini G, Damy T, Dispenzieri A, et al. Nonbiopsy Diagnosis of Cardiac Transthyretin Amyloidosis. Circulation. 2016;133(24):2404-12.
6. Nitsche C, Kammerlander AA, Knechtelsdorfer K, Kraiger JA, Goliasch G, Dona C, et al. Determinants of Bioprosthetic Aortic Valve Degeneration. JACC Cardiovascular imaging. 2019.
7. Nitsche C, Kammerlander AA, Binder C, Duca F, Aschauer S, Koschutnik M, et al. Native T1 time of right ventricular insertion points by cardiac magnetic resonance: relation with invasive haemodynamics and outcome in heart failure with preserved ejection fraction. European heart journal cardiovascular Imaging. 2019.
8. Nitsche C, Kammerlander AA, Koschutnik M, Donà C, Aschauer S, Sinnhuber L, et al. Volume Status Impacts CMR–Extracellular Volume Measurements and Outcome in AS Undergoing TAVR. JACC: Cardiovascular Imaging. 2020.