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Abnormal protein in the heart of patients referred for minimally invasive heart valve surgery

A significant proportion of elderly men and women referred for minimially invasive heart valve surgery, also have a build-up of an abnormal protein (amyloid) in their heart muscle, which causes thickening and stiffening of their hearts.

1 in 7 patients (aged 75 and over) referred for minimally invasive heart valve surgery (known as transcatheter aortic valve implantation or TAVI) have been found to have this amyloid within the heart muscle itself, which causes it to become thicker and restricts the movement of the muscle (restrictive cardiomyopathy).  Initially it is the filling function of the heart that is affected and so the heart muscle is unable to relax for the ventricles to adequately fill with blood.  As the protein continues to build up the actual pumping of heart can also become affected. 

TAVI is used to treat patients who have a narrowing of their aortic valve opening (aortic stenosis), which normally allows blood to flow to the rest of the body.

Previously, diagnosing amyloid in the heart has required an invasive procedure to get a tissue sample from the heart. We are now able however to screen for amyloid using a non-invasive nuclear medicine bone scan (DPD scintigraphy).  Only a few centres in the UK routinely use DPD scintigraphy to diagnose patients with amyloid in their heart.

Research is ongoing to establish the impact this amyloid in the heart, has on recovery and symptom benefit following the TAVI procedure.

Dr Leon Menezes, a Consultant at UCLH and Barts Heart Centre, is an author on the paper and has established DPD scanning at both centres.  He also receives BRC support for his research. 

To read the full paper please visit Journal of the American College of Cardiology