Unveiling cardiac amyloidosis, its characteristics and outcomes among patients with mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair

Abstract Background Mitral regurgitation (MR) and cardiac amyloidosis (CA) both primarily affect older patients. Data on co-existence prognostic implications of MR CA are currently lacking. Purpose We aimed to identify prevalence, clinical characteristics outcomes MR-CA compared lone MR. Methods Consecutive patients undergoing transcatheter edge-to-edge repair (TEER) for were screened concomitant at two Austrian centers using a multi-parametric approach including core-lab 99mTc-DPD bone scintigraphy echocardiography, immunoglobulin light-chain assessment. Transthyretin-CA (ATTR) was diagnosed by DPD (Perugini Grade-1: early infiltration; Grades-2/3: CA) absence monoclonal protein, light-chain-(AL)-CA via tissue biopsy. Mass spectroscopy performed in case conflicting immunohistochemical results. All-cause mortality hospitalization heart failure (HHF) served as composite endpoint. Results In total, 120 (76.9±8.1 years, 55.8% male) recruited. Clinical n=14 (11.7%; 12 ATTR, 1 AL, combined ATTR/AL), amyloid infiltration n=9 (7.5%). had higher troponin levels, thicker left ventricular walls, prevalence carpal tunnel syndrome anterior fascicular block (all p<0.05). Independent predictors increased posterior wall thickness, presence ECG. Procedural success (MR reduction ≥1 grade) periprocedural complications TEER similar (p all=n.s.). After median 1.7 25.8% experienced death and/or HHF. worse with regard the endpoint (HR 2.2, 95% confidence interval [95% CI] 1.0–4.7, p=0.039), driven 2.5-fold risk HHF 2.5, CI 1.1–5.9), but comparable 1.6, 0.4–6.1; Graphical abstract). Conclusions Dual pathology is common elderly TEER, has post-interventional Given technical feasibility MR-CA, valvular should be considered an option improve forward volume state typically low output. Future studies evaluate benefits CA-specific treatment MR-CA. Funding Acknowledgement Type funding sources: None.