ABSTRACT
Background: Transthyretin cardiac amyloidosis (ATTR-CM) is important comorbidity associated with severe aortic stenosis (AS). Multiple studies have shown that ATTR-CM was present in 10-15% of all cases with severe AS. The purpose of this quality improvement project is to raise awareness of ATTR-CM in patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS amongst the healthcare providers and patients. Methods: We retrospectively reviewed all TAVR cases performed at our institution in 2019 (Total cases 87). We screened for the presence of predefined high-risk features for ATTR-CM based on prior literature (Presence of diastolic dysfunction, left ventricular hypertrophy on echocardiogram, low voltage-mass ratio, low limb lead voltage on EKG, arrhythmia/bundle branch block, or systemic symptoms of amyloidosis). We subsequently contacted the patients to discuss our clinical suspicion of ATTR-CM and offered clinical referral to a cardiac amyloid specialist. Results: Of the total of 87 patients who underwent TAVR in 2019, 12 patients were deceased at chart review. We have identified 50 patients (66.7%) who had high-risk features of ATTR-CM. A total of 17 patients (34% of 50 patients) agreed to be referred to cardiac amyloid specialist. Six patients (12%) were tested with 99m Technetium Pyrophosphate imaging, and all were negative for ATTR-CM. Eleven patients (22%) are still pending testing. Six patients did not wish for referral due to personal reasons. We were not able to reach 15 patients via phone (30%). In addition, we have found additional 12 patients who were deceased (Total mortality count of 24, 27.5%) in two years. Conclusion: Our project has increased awareness within structural cardiologists as we have implemented a prospective screening process within our institution. While we expected to diagnose ATTR-CM in 10% of severe AS who underwent TAVR, we had multiple difficulties contacting them, coordinating referrals due to the COVID-19 pandemic and higher 2-year mortality. We are hypothesizing whether the higher 2-year mortality is secondary to undetected ATTR-CM. We are planning for screening and timely referral for patients who underwent TAVR more recently.