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Aortic Valve Stenosis and Cardiac Amyloidosis: A Misleading Association

Andrea Bonelli1, Sara Paris1, Matilde Nardi1

  • 1Cardiology Unit, Spedali Civili and University of Brescia, 25100 Brescia, Italy.

Journal of Clinical Medicine
|September 28, 2021
PubMed

Insights

Cardiac amyloidosis (CA), especially transthyretin (ATTR)-CA, is often found with aortic stenosis (AS). Early diagnosis using non-invasive methods is crucial for managing these intertwined conditions.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Amyloidosis Research

Background:

  • The co-occurrence of aortic stenosis (AS) and cardiac amyloidosis (CA) is more common than previously recognized.
  • Transthyretin cardiac amyloidosis (ATTR-CA) is the predominant form of CA in patients with AS, frequently affecting elderly individuals.

Purpose of the Study:

  • To review the shared pathophysiological characteristics, clinical presentations, and imaging findings of AS and CA.
  • To highlight the diagnostic challenges and the importance of early detection of the AS-CA association.

Main Methods:

  • Discussion of multiparametric evaluation strategies for detecting concurrent AS and CA.
  • Emphasis on the role of modern non-invasive techniques, such as bone scintigraphy, for early CA diagnosis.

Main Results:

  • ATTR-CA is the most prevalent type of CA in patients with AS.
  • Accurate non-invasive imaging techniques facilitate early diagnosis of CA.
  • Flow-charts are proposed to aid clinicians in diagnosing CA.

Conclusions:

  • The combination of AS and CA presents diagnostic challenges due to overlapping features.
  • Early identification of AS-CA is critical, particularly with emerging specific treatments for ATTR-CA.
  • Understanding the AS-CA association impacts therapeutic decision-making for AS management.

Keywords:
amyloidosisaortic valve stenosismultimodality imagingtransthyretin amyloidosis

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