Prospective cascade screening for transthyretin amyloid cardiomyopathy in patients undergoing spinal stenosis surgery: results of the CASS (Cardiac Amyloidosis in Spinal Stenosis) study

Abstract Funding Acknowledgements Type of funding sources: None. Background Ligamentum flavum hypertrophy due to transthyretin amyloid (ATTR) deposition is common in patients with symptomatic spinal stenosis, although prospective data on systematic screening for coinciding ATTR-cardiomyopathy (CM) are lacking. Purpose To evaluate a strategy identify de novo ATTR-CM all-comers undergoing stenosis surgery. Methods Patients surgery were prospectively screened potential increased risk, based predefined criteria electrocardiography, laboratory (hs-troponin, NT-proBNP), echocardiography and peroperative ligamentum histology. ≥1 Positive mandated exclusion by HMDP-bonescintigraphy. Results In total 82 consecutive (mean age 68±9 years, 48% males) underwent cascade screening. 90% positive risk criterium was noted 4.1% (n=3/74, 67% male) identified ATTR-CM. Importantly, 59% (n=48/82) had ATTR biopsy, which 21% (n=10/48) being <60 years old. burden histology age, the sole independent predictor presence (HR 1.15, 95%CI 1.07–1.22, p<0.001). High (Westermark grade 4, ≥10% histology) 12% (n=10/82). All 3 high burden, translating into prevalence predictive value (PPV) 30% (n=3/10) 85% accuracy Westermark 4 patients. Other markers PPV>5% hs-troponin, left ventricular wall thickness ≥12mm, global longitudinal strain >-20% relative apical sparing. Conclusions during relates coincident