Cardiac amyloidosis affects up to 15% of the aortic stenosis population and up to 30% of those with low-flow, low-gradient patterns, increasing the risk of heart failure and mortality.
Cardiac amyloidosis frequently coexists with aortic stenosis in the elderly, worsening prognosis and potentially favoring transcatheter aortic valve replacement over surgical valve replacement.
The prevalence of calcific aortic stenosis (AS) and of cardiac amyloidosis (CA) increases with age, and their association is not uncommon in the elderly. The identification of CA is particularly challenging in patients with AS because these 2 conditions share several features. It is estimated that ≤15% of the AS population and ≤30% of the subset with low-flow, low-gradient pattern may have CA. In patients with AS, CA is associated with increased risk of heart failure, mortality, and treatment futility with aortic valve replacement. In case of suspicion of CA, it is thus crucial to confirm the diagnosis to guide therapeutic management of AS and eventually implement recently developed pharmacological treatment dedicated to transthyretin amyloidosis. Given the high surgical risk of patients with AS and concomitant CA, transcatheter aortic valve replacement may be preferred to surgery in these patients.
Ternacle et al. (2019) conducted a review in Calcific aortic stenosis and cardiac amyloidosis. Cardiac amyloidosis affects up to 15% of the aortic stenosis population and up to 30% of those with low-flow, low-gradient patterns, increasing the risk of heart failure and mortality.