Impact of cardiac amyloidosis on survival in aortic stenosis patients undergoing TAVR: a systematic review and reconstructed time-to-event meta-analysis.

Abstract

New evidence suggests a relatively high prevalence of occult cardiac amyloidosis (CA) among patients with aortic stenosis (AS). While transcatheter aortic valve replacement (TAVR) is an established treatment for AS, the impact of concomitant CA on long-term outcomes remains unclear. We conducted a systematic review and meta-analysis to evaluate survival and procedural outcomes of TAVR in AS patients with and without CA. PubMed, Scopus, Web of Science, Google Scholar, and the Cochrane Library were searched through 21 April 2026. Studies comparing outcomes of TAVR in patients with and without CA and reporting Kaplan-Meier survival curves were included. Individual patient survival data were extracted from Kaplan-Meier curves and reconstructed for pooled analysis. Secondary outcomes were analyzed using random-effects meta-analysis. Seven studies including 2747 patients were analyzed. In the primary analysis, which included both definitive and probability-based definitions of CA, CA was associated with increased all-cause mortality following TAVR (HR: 1.58; 95% CI 1.23, 2.03; P < 0.001). However, in a sensitivity analysis restricted to studies with confirmed CA, this association was no longer significant (HR: 1.32, 95% CI 0.84, 2.07, P = 0.226). There were no significant differences in pacemaker implantation (OR: 1.33; 95% CI 0.69, 2.56; P = 0.40) or more than mild aortic regurgitation (OR: 0.96; 95% CI 0.25, 3.78; P = 0.96). The association between CA mortality after TAVR in AS patients is highly dependent on how CA is defined. While analyses including screening-based cohorts suggest increased risk, this was not observed in analyses of studies with confirmed CA. These findings highlight the impact of differing diagnostic approaches in CA and underscore the need for future studies to use standardized criteria and prospective designs to clarify the independent prognostic role of confirmed CA.