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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of University of South Florida waived ethical approval for this work. (STUDY000938) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. * AS : Aortic stenosis ATTR : Transthyretin cardiac amyloidosis CA : Cardiac amyloidosis EKG : Electrocardiogram IVS : Interventricular septum LV : Left ventricle PWD : Posterior wall dimension PYP : pyrophosphate TAVR : transcatheter aortic valve replacement 99mTc-PYP : 99m Technetium pyrophosphate