# Significant valvular heart disease in wild-type transthyretin amyloidosis: prevalence and impact on survival

## TL;DR

This study finds that significant tricuspid regurgitation is common in wild-type transthyretin amyloidosis and is linked to higher mortality.

## Contribution

The study is the first to report the prevalence and survival impact of valvular heart disease in wild-type transthyretin amyloidosis patients.

## Key findings

- Significant tricuspid regurgitation was the most prevalent valvular disease (27%) in the study population.
- Patients with significant tricuspid regurgitation had higher all-cause mortality (41% vs. 16%).
- Tricuspid regurgitation was independently associated with higher mortality in multivariable analysis.

## Abstract

There are limited data on the prevalence and prognostic impact of significant valvular heart disease in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt). The aim of this study was to describe the prevalence of aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR) in this population and, secondarily, to evaluate their impact on survival.

This was a retrospective, single-center cohort study including patients diagnosed with ATTRwt between 2011 and 2024. We calculated the prevalence of each significant valvular heart disease, and Kaplan-Meier survival curves were generated to estimate two-year all-cause mortality, stratified according to the presence or absence of each significant valvular disease. Finally, a multivariable Cox regression was performed to assess their association with survival.

We included 154 patients, with a mean age of 81 (±7) years; 85% (n=131) were male. Significant TR was the most prevalent valvular disease (27%, n=41), followed by significant MR (20%, n=30) and AS (13%, n=20). Patients with significant TR had a higher incidence of all-cause mortality compared to those without significant TR (41% vs. 16%, log-rank test, p=0.0007), whereas no differences were observed between patients with and without significant AS or MR. In multivariable Cox models, significant TR was independently associated with higher mortality, regardless of age, the presence of other valvular diseases, and NT-proBNP levels.

Significant TR was the most prevalent valvular disease in patients with ATTRwt and was associated with lower survival in this population.