HFSA ePoster Library

Introduction: Cardiac transthyretin amyloidosis (CA-ATTR) is a treatable condition that may co-exist in patients with paradoxical low-flow, low-gradient aortic stenosis (LFLG-AS) with normal ejection fraction (EF) undergoing transcatheter aortic valve replacement (TAVR). CA-ATTR is associated with non-cardiac clinical conditions such as carpel tunnel syndrome, lumbar spinal stenosis, biceps tendon rupture, peripheral neuropathy, and autonomic dysfunction. Hypothesis: We hypothesized that the prevalence of these associated conditions in paradoxical LFLG-AS patients undergoing TAVR is higher than the reported diagnosis of CA-ATTR in this population.
Methods: The electronic medical record was used to identify patients with severe LFLG-AS (mean aortic valve gradient <40mmHg, aortic valve area <1cm²) with normal EF(>50%). Patients were excluded for bicuspid aortic valve or valve-in-valve procedure. Charts were reviewed retrospectively to determine if CA-ATTR was diagnosed and if CA-ATTR associated clinical conditions were present; these were summarized with descriptive statistics.
Results: A total of 278 patients met inclusion/exclusion criteria. Table 1 shows the prevalence of CA-ATTR associated clinical conditions. There were no patients identified with a diagnosis of CA-ATTR. Having a CA-ATTR associated clinic condition did not predict 1 year-post TAVR NYHA class or all-cause mortality using a multivariable regression model.
Conclusion: No patients had been diagnosed with CA-ATTR in our cohort of paradoxical LFLG-AS, despite a high prevalence of associated clinical conditions. Our results support the need for standardized screening measures for CA-ATTR in the paradoxical LFLG-AS population.

Table 1: Prevalence of CA-ATTR associated clinical conditions in paradoxical LFLG-AS

	(N=278)
Peripheral Neuropathy, n (%)	52 (18.7)
Carpel Tunnel, n (%)	37 (13.3)
Biceps tendon rupture, n (%)	8 (2.9)
Lumbar spinal stenosis, n (%)	16 (5.8)
Autonomic dysfunction/postural hypotension, n (%)	27 (9.7)