Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology..
AIMS: Wildtype transthyretin amyloid cardiomyopathy is an under-recognized cause of heart failure in elderly patients. Transcatheter tricuspid valve repair is a newly emerging therapeutic option for severe tricuspid regurgitation (TR). We present first insights into safety and possible benefits of this procedure in patients with cardiac amyloidosis.
METHODS AND RESULTS: Eight patients with cardiac non-hereditary (wildtype) transthyretin (ATTRwt) amyloidosis and severe to torrential TR, undergoing successful transcatheter tricuspid valve repair, were included in the analysis and compared to a control group of 21 patients without cardiac amyloidosis. All patients presented with an advanced stage of amyloid cardiomyopathy. Primary endpoint was reduction in TR at 3 months follow-up. Secondary endpoints were feasibility, safety, hospitalization or death, clinical improvement, cardiac biomarkers, and structural and functional right heart parameter obtained by echocardiography. Transcatheter tricuspid valve repair resulted in a significant reduction of TR (IV to II, P = 0.008) in all eight patients with cardiac amyloidosis (100%). Device success (amyloidosis 75% vs. control group 86%, P = 0.597) and overall probability of hospitalization or death (amyloidosis 13% vs. control group 25%, P = 0.646) were similar compared with those in the control group at 3 months follow-up. Transcatheter tricuspid valve repair led to an improvement of New York Heart Association functional class (P = 0.031) and 6 min walking distance (from 313 ± 118 to 337 ± 106, P = 0.012). TR reduction in amyloidosis patients was less extensive compared with that in control group (TR-reduction 1.6 ± 0.3, P = 0.008 vs. control group 2.3 ± 0.3, P < 0.0001). Furthermore, these patients showed no significant improvement of structural right heart parameters.
CONCLUSIONS: Transcatheter tricuspid valve repair is a safe and feasible new treatment option in patients with amyloid cardiomyopathy and has the potential to improve TR-grade and clinical status. However, the benefit appears to be less pronounced compared with patients without cardiac amyloidosis.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:10 |
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| Enthalten in: |
ESC heart failure - 10(2023), 2 vom: 26. Apr., Seite 1003-1012 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hoerbrand, Isabel A [VerfasserIn] |
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| Links: |
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| Themen: |
Amyloid cardiomyopathy |
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| Anmerkungen: |
Date Completed 28.08.2023 Date Revised 28.08.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/ehf2.14262 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM350262659 |
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| 245 | 1 | 0 | |a Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. | ||
| 520 | |a AIMS: Wildtype transthyretin amyloid cardiomyopathy is an under-recognized cause of heart failure in elderly patients. Transcatheter tricuspid valve repair is a newly emerging therapeutic option for severe tricuspid regurgitation (TR). We present first insights into safety and possible benefits of this procedure in patients with cardiac amyloidosis | ||
| 520 | |a METHODS AND RESULTS: Eight patients with cardiac non-hereditary (wildtype) transthyretin (ATTRwt) amyloidosis and severe to torrential TR, undergoing successful transcatheter tricuspid valve repair, were included in the analysis and compared to a control group of 21 patients without cardiac amyloidosis. All patients presented with an advanced stage of amyloid cardiomyopathy. Primary endpoint was reduction in TR at 3 months follow-up. Secondary endpoints were feasibility, safety, hospitalization or death, clinical improvement, cardiac biomarkers, and structural and functional right heart parameter obtained by echocardiography. Transcatheter tricuspid valve repair resulted in a significant reduction of TR (IV to II, P = 0.008) in all eight patients with cardiac amyloidosis (100%). Device success (amyloidosis 75% vs. control group 86%, P = 0.597) and overall probability of hospitalization or death (amyloidosis 13% vs. control group 25%, P = 0.646) were similar compared with those in the control group at 3 months follow-up. Transcatheter tricuspid valve repair led to an improvement of New York Heart Association functional class (P = 0.031) and 6 min walking distance (from 313 ± 118 to 337 ± 106, P = 0.012). TR reduction in amyloidosis patients was less extensive compared with that in control group (TR-reduction 1.6 ± 0.3, P = 0.008 vs. control group 2.3 ± 0.3, P < 0.0001). Furthermore, these patients showed no significant improvement of structural right heart parameters | ||
| 520 | |a CONCLUSIONS: Transcatheter tricuspid valve repair is a safe and feasible new treatment option in patients with amyloid cardiomyopathy and has the potential to improve TR-grade and clinical status. However, the benefit appears to be less pronounced compared with patients without cardiac amyloidosis | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Amyloid cardiomyopathy | |
| 650 | 4 | |a Cardiac amyloidosis | |
| 650 | 4 | |a Transcatheter tricuspid valve repair | |
| 650 | 4 | |a Tricuspid regurgitation | |
| 650 | 7 | |a Prealbumin |2 NLM | |
| 700 | 1 | |a Volz, Martin J |e verfasserin |4 aut | |
| 700 | 1 | |a Aus dem Siepen, Fabian |e verfasserin |4 aut | |
| 700 | 1 | |a Aurich, Matthias |e verfasserin |4 aut | |
| 700 | 1 | |a Schlegel, Philipp |e verfasserin |4 aut | |
| 700 | 1 | |a Geis, Nicolas A |e verfasserin |4 aut | |
| 700 | 1 | |a Hegenbart, Ute |e verfasserin |4 aut | |
| 700 | 1 | |a Konstandin, Mathias H |e verfasserin |4 aut | |
| 700 | 1 | |a Frey, Norbert |e verfasserin |4 aut | |
| 700 | 1 | |a Raake, Philip W |e verfasserin |4 aut | |
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