Valvulopatías significativas en amiloidosis por transtiretina wild-type: prevalencia e impacto en la sobrevida

Santiago Decotto; Pilar Domenech; Pedro Touzas; María Adela Aguirre; Elsa Nucifora; María Lourdes Posadas-Martínez; Rocío Blanco; Mariano Falconi; Rodolfo Pizarro; Diego Pérez de Arenaza

doi:10.47487/apcyccv.v6i3.524

Authors

Santiago Decotto Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0000-0003-1186-4376
Pilar Domenech Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0009-0006-7500-4104
Pedro Touzas Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0009-0003-0056-7330
María Adela Aguirre Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0000-0001-9690-2284
Elsa Nucifora Servicio de Hematología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0000-0003-2177-7727
María Lourdes Posadas-Martínez Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0000-0003-1403-7069
Rocío Blanco Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0000-0001-5806-2755
Mariano Falconi Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0000-0001-9624-6424
Rodolfo Pizarro Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0009-0003-8063-8820
Diego Pérez de Arenaza Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. https://orcid.org/0000-0002-8582-5065

DOI:

https://doi.org/10.47487/apcyccv.v6i3.524

Keywords:

Amyloidosis, Transthyretin, Valvular Heart Diseases, Tricuspid regurgitation

Abstract

Objective. There are limited data on the prevalence and prognostic impact of significant valvular heart disease in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt). The aim of this study was to describe the prevalence of aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR) in this population and, secondarily, to evaluate their impact on survival. Methods. This was a retrospective, single-center cohort study including patients diagnosed with ATTRwt between 2011 and 2024. We calculated the prevalence of each significant valvular heart disease, and Kaplan-Meier survival curves were generated to estimate two-year all-cause mortality, stratified according to the presence or absence of each significant valvular disease. Finally, a multivariable Cox regression was performed to assess their association with survival. Results. We included 154 patients, with a mean age of 81 (±7) years; 85% (n=131) were male. Significant TR was the most prevalent valvular disease (27%, n=41), followed by significant MR (20%, n=30) and AS (13%, n=20). Patients with significant TR had a higher incidence of all-cause mortality compared to those without significant TR (41% vs. 16%, log-rank test, p=0.0007), whereas no differences were observed between patients with and without significant AS or MR. In multivariable Cox models, significant TR was independently associated with higher mortality, regardless of age, the presence of other valvular diseases, and NT-proBNP levels. Conclusions. Significant TR was the most prevalent valvular disease in patients with ATTRwt and was associated with lower survival in this population.

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