{"id":"c5a71cfa9a8c","type":"article","url":"https://hartvaat.nl/2026/10/01/cardiale-amyloidose-komt-bij-9-van-tavi-patienten-voor-ongeacht-stromingspatroon/","title":"Cardiale amyloidose komt bij 9% van TAVI-patiënten voor — ongeacht stromingspatroon","title_en":"Dual pathology in aortic stenosis: Identifying transthyretin amyloidosis likelihood in patients referred for transcatheter aortic valve implantation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"International journal of cardiology. Heart & vasculature","doi":"10.1016/j.ijcha.2026.101991","source_url":"https://doi.org/10.1016/j.ijcha.2026.101991","authors":["Stéphanie Kristina Schwarting","Selen Alieva","Mohammad Usama Chaudhry","Kornelia Löw","Sergio Grosu","Steffen Massberg","Simon Deseive","Julius Steffen"],"significance":5,"published":"2026-08-27","source_date":"2026-10-01","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/aortastenose/","https://hartvaat.nl/kennis/kleplijden/tavi-transcatheter-aortaklepimplantatie/"],"congress":"","summary_en":"A retrospective analysis of 2,764 patients undergoing TAVI for severe aortic stenosis found a high likelihood of coexisting transthyretin cardiac amyloidosis in 9% of cases, regardless of the aortic stenosis flow pattern. While procedural success was similar, patients with dual pathology had a higher 3-year all-cause mortality (44% vs 29%), an association that was largely attenuated after adjustment for baseline surgical risk (STS score). These findings suggest that cardiac amyloidosis is relatively common in the TAVI population and contributes to long-term mortality primarily through underlying patient risk rather than procedural complications. Routine consideration of amyloidosis screening may improve prognostic stratification, though it does not currently alter TAVI technique.","created":"2026-08-21T00:50:59Z","updated":"2026-08-21T00:50:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een retrospectieve analyse van 2764 patiënten die een TAVI ondergingen voor ernstige aortastenose, bleek in 9% van de gevallen een hoge waarschijnlijkheid op gelijktijdige transthyretine-cardiale amyloidose (CA). Deze co-morbiditeit kwam in alle stromingsgroepen voor en ging niet gepaard met een lager procedureel succes, maar wel met een hogere 3-jaars mortaliteit (44% versus 29%). Na correctie voor de STS-risicoscore verdween het overlevingseffect grotendeels, wat suggereert dat het verhoogde sterftecijfer vooral voortkomt uit de onderliggende patiëntkenmerken. Voor cardiologen betekent dit dat screening op CA bij TAVI-kandidaten zinvol kan zijn voor prognosebegeleiding, maar niet direct de procedurele aanpak verandert.","abstract_original":"BACKGROUND: Aortic stenosis (AS) and transthyretin cardiac amyloidosis (CA) may coexist with overlapping clinical and imaging features. Data on the prevalence of this dual pathology (AS-CA) across AS flow groups are limited. This study assessed the likelihood of AS-CA in different AS flow groups and its association with outcomes after transcatheter aortic valve implantation (TAVI). METHODS: We retrospectively analyzed 2764 patients (median age 82 years, 55% male) undergoing TAVI for severe native AS between 2017 and 2022). High likelihood of AS-CA was defined as RAISE score ≥ 3 points together with a T-AMYLO score ≥ 3 + red-flag criteria, or a T-AMYLO score ≥ 7 points. Procedural outcomes and long-term survival were evaluated. RESULTS: High AS-CA likelihood was identified in 235 patients (9%). The estimated likelihood was comparable across AS flow groups, including high-gradient (7.4%), classical low-flow low-gradient (10.6%), paradoxical low-flow low-gradient (9.9%), and normal-flow high-gradient AS patients (7.7%) (p = 0.09). Procedural success after TAVI did not differ between patients with AS-CA and lone AS. However, AS-CA likelihood was associated with a higher 3-year all-cause mortality (44% vs. 29%, p < 0.001). This association was attenuated after adjustment for Society of Thoracic Surgeons (STS) risk score (HR 1.2 [95% CI 0.99-1.53], p = 0.065). CONCLUSION: Dual pathology of AS-CA is likely present in approximately 9% of TAVI patients and is not confined to specific AS flow groups. Although procedural outcomes are comparable, AS-CA is associated with increased mortality, largely driven by baseline risk. Further studies are needed to improve diagnostic strategies and clarify the underlying mechanisms."}