Publication date: Oct 22, 2024

The relative apical sparing pattern of left ventricular (LV) longitudinal strain (RELAPS]>1) has been described as a typical sign of cardiac amyloidosis (CA). The objective was to validate this pattern in concomitant CA and aortic stenosis (AS) and to identify new echocardiographic variables suggestive of CA in the presence of AS. 324 consecutive patients (age 81. 5+/-5. 8 years, 51% women) with AS who underwent transcatheter aortic valve implantation (TAVI) were prospectively included. 2D-Speckle-tracking echocardiography was performed. Following TAVI, 99mTc-DPD-scintigraphy and protein electrophoresis were performed to screen for CA. 38 patients (11. 7%) showed cardiac uptake in scintigraphy: 14 patients (4. 3%) with grade 1, 13 (4%) with grade 2, and 11 (3. 4%) with grade 3. Patients with grades 2 and 3 (AS-CA group) had more LV hypertrophy (LV mass index: 188 vs. 172 g/m2, p=0. 032), lower transvalvular aortic pressure gradient (p1 was more prevalent in AS-CA group (74% vs. 44%, p=0. 006). An echocardiographic prediction model (GRAM score) for CA in the presence of AS, that is more sensitive and specific than RELAPS>1 alone, is proposed using the LV mass, maximum aortic gradient, and RELAPS>1, in addition to age (AUC:0. 85, 95%CI: 0. 77-0. 93). RELAPS>1 is more prevalent in AS-CA but can occur in almost half of AS patients without CA, which reduces its value as a screening tool. A more sensitive and specific prediction score for CA in patients with severe AS is proposed.

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