Referral for Cardiac Amyloidosis in Patients who underwent Transcatheter Aortic Valve Replacement: Result of Quality Outcome Project

Introduction Transthyretin cardiac amyloidosis (ATTR) is important comorbidity present in 10-15% of severe aortic stenosis (AS). The purpose of this study was to raise awareness of ATTR in patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS among healthcare providers and patients. Methods We reviewed 197 consecutive TAVR cases performed from 2019-2020. Based on the presence of predefined high-risk features for ATTR based on prior literature, we subsequently contacted the patients to discuss our clinical suspicion of ATTR and offered a referral to a cardiac amyloid specialist. Results We have identified 125 patients (69.4%) who had high-risk features of ATTR. Of the 105 patients who we were able to contact, 44 patients agreed to referral, 46 patients were not able to be contacted after several attempts, and 15 patients declined referral. Of the 44 patients who agreed to referral, 20 patients completed the evaluation for cardiac amyloidosis, all of which were negative for transthyretin and light chain cardiac amyloidosis. Conclusion In conclusion, our attempt to detect ATTR in prior TAVR patients was unsuccessful after 2-3 years post-TAVR. We believe that early detection of cardiac amyloidosis close to the timing of TAVR is important and the most effective means.