[Cardiac amyloidosis and aortic stenosis: what do we know?]

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Amyloidosis Research

Background:

• Aortic valve stenosis (AVS) and cardiac amyloidosis (CA), particularly transthyretin-related, frequently coexist.
• Shared clinical and demographic profiles suggest underlying pathophysiological links, though not fully elucidated.
• Clinical suspicion is crucial for detecting concurrent CA in AVS patients.

Purpose of the Study:

• To highlight the importance of recognizing the coexistence of AVS and CA.
• To outline diagnostic strategies for identifying dual pathology.
• To review current treatment approaches and their impact on patient outcomes.

Main Methods:

• Review of clinical, electrocardiographic, echocardiographic, and extracardiac "red flags" for diagnosing concurrent CA in AVS.
• Discussion of non-invasive diagnostic steps for definitive diagnosis.
• Analysis of available treatment data comparing percutaneous interventions with medical therapy.

Main Results:

• Early diagnosis of dual pathology is critical as it worsens prognosis without intervention.
• Percutaneous correction of valvular heart disease shows better survival and fewer cardiovascular events than medical therapy alone.
• Cardiac amyloidosis does not appear to significantly impact survival post-transcatheter aortic valve replacement (TAVR), despite increased rehospitalizations.

Conclusions:

• Percutaneous treatment of valvular heart disease is the primary therapeutic strategy for patients with AVS and CA.
• Disease-modifying therapies for transthyretin amyloidosis may be considered post-TAVR to delay progression, pending further data.
• Integrated management focusing on timely intervention is key for improving outcomes in this complex patient group.