European journal of preventive cardiology · 2026
Screening for amyloidosis before aortic valve elective replacement: results from the SAVER study.
СтатьяНазвание и аннотация: Перевод в очереди
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Mattig Isabel, Wrede-Wihl Katrin, Sökmen Selin, Huscher Dörte, Wetz Christoph, Heidecker Bettina, Barzen Gina, Pernice Helena, Klein Christoph, Unbehaun Axel, Sherif Mohammad, Brand Anna, Leistner David, Spethmann Sebastian, Stangl Karl, Hindricks Gerhard, Dreger Henryk, Hahn Katrin, Knebel Fabian, Messroghli Daniel
Аннотация
AIMS: Concomitant aortic stenosis (AS) and cardiac amyloidosis (CA) result in heart failure and reduced life expectancy. Early detection of CA in AS is an unmet clinical need to prevent disease progression. The SAVER study aims to establish a simple CA screening for AS patients.
METHODS AND RESULTS: SAVER is a prospective cohort study enrolling AS patients planned for transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Firstly, patients were assessed for CA-specific symptoms and history on top of AS evaluation. Patients with suspected CA underwent DPD scintigraphy or magnetic resonance imaging. Secondly, we performed multiple-regression analysis to identify optimal parameters for selecting patients at risk of CA. From 2021 to 2023, 1001 patients were enrolled, with 405 (40%) flagged for potential CA. Two hundred six (21%) patients received further diagnostics due to the screening and five (0.5%) patients due to physician discretion, leading to 17 (2%) confirmed CA cases. Key predictors of CA included male sex [OR 23.8 (95% CI 2.6; 216.9)], carpal tunnel syndrome [OR 5.5 (95% CI 1.4; 22.0)], spinal stenosis [OR 4.1 (95% CI 1.1; 14.7)], heaviness or numbness of arms or legs [OR 3.8 (95% CI 1.1; 13.3)], NT-proBNP [OR 6.7 (95% CI 1.8; 25.3)], and sparkling myocardium [OR 4.8 (95% CI 1.3; 17.3)]. The optimized approach reached an AUC of 0.88 (95% CI 0.81-0.96).
CONCLUSION: The SAVER approach is the first holistic screening method focusing on CA's multiorgan manifestations in AS. This approach can be implemented in clinical settings to prevent futile outcomes of combined disease.
METHODS AND RESULTS: SAVER is a prospective cohort study enrolling AS patients planned for transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Firstly, patients were assessed for CA-specific symptoms and history on top of AS evaluation. Patients with suspected CA underwent DPD scintigraphy or magnetic resonance imaging. Secondly, we performed multiple-regression analysis to identify optimal parameters for selecting patients at risk of CA. From 2021 to 2023, 1001 patients were enrolled, with 405 (40%) flagged for potential CA. Two hundred six (21%) patients received further diagnostics due to the screening and five (0.5%) patients due to physician discretion, leading to 17 (2%) confirmed CA cases. Key predictors of CA included male sex [OR 23.8 (95% CI 2.6; 216.9)], carpal tunnel syndrome [OR 5.5 (95% CI 1.4; 22.0)], spinal stenosis [OR 4.1 (95% CI 1.1; 14.7)], heaviness or numbness of arms or legs [OR 3.8 (95% CI 1.1; 13.3)], NT-proBNP [OR 6.7 (95% CI 1.8; 25.3)], and sparkling myocardium [OR 4.8 (95% CI 1.3; 17.3)]. The optimized approach reached an AUC of 0.88 (95% CI 0.81-0.96).
CONCLUSION: The SAVER approach is the first holistic screening method focusing on CA's multiorgan manifestations in AS. This approach can be implemented in clinical settings to prevent futile outcomes of combined disease.