Dual pathology in aortic stenosis: Identifying transthyretin amyloidosis likelihood in patients referred for transcatheter aortic valve implantation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe native aortic stenosis (n=2764). Intervention: High likelihood of concomitant cardiac amyloidosis (AS-CA) vs. Lone aortic stenosis. Primary outcome: 3-year all-cause mortality (adjusted for STS score) (HR 1.2, 95% CI 0.99-1.53, p=0.065).

Q: What does this research mean for the field?

Dual pathology of aortic stenosis and cardiac amyloidosis is present in approximately 9% of patients undergoing TAVI across all flow groups and is associated with increased post-procedural mortality largely driven by baseline risk. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Stéphanie Kristina Schwarting; Selen Alieva; Mohammad Usama Chaudhry; Kornelia Löw; Sergio Grosu; Steffen Maßberg; Simon Deseive; Julius Steffen

doi:10.1016/j.ijcha.2026.101991

August 12, 2026IJC Heart & VasculatureOpen Access

Dual pathology in aortic stenosis: Identifying transthyretin amyloidosis likelihood in patients referred for transcatheter aortic valve implantation

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Key result

A high likelihood of concomitant cardiac amyloidosis in patients undergoing TAVI was associated with higher 3-year mortality (44% vs 29%), which was attenuated after adjustment for baseline risk (HR 1.2, p=0.065).

Figures

Why the study?

Data on the prevalence of coexisting aortic stenosis and transthyretin cardiac amyloidosis across AS flow groups are limited.

Does the likelihood of concomitant cardiac amyloidosis affect procedural outcomes and long-term survival in patients undergoing TAVI for severe aortic stenosis?

Study Design

Type

Cohort (n=2,764)

Multicenter

No

Structured PICO

Does the likelihood of concomitant cardiac amyloidosis affect procedural outcomes and long-term survival in patients undergoing TAVI for severe aortic stenosis?

P

Population

2,764 patients with severe native aortic stenosis undergoing transcatheter aortic valve implantation, evaluated retrospectively for the likelihood of concomitant cardiac amyloidosis and followed for up to 3 years.

E

Exposure

Transcatheter aortic valve implantation (TAVI) in patients with a high likelihood of dual pathology of aortic stenosis and cardiac amyloidosis (AS-CA), defined by concordant positivity of RAISE and T-AMYLO scores.

C

Comparator

Transcatheter aortic valve implantation (TAVI) in patients with lone aortic stenosis (low likelihood of cardiac amyloidosis).

O

Outcome

Combined Valve Academic Research Consortium 3 (VARC-3) endpoints and 3-year all-cause mortality following TAVI.composite

Main Result

Hazard Ratio: 1.2 (95% CI 0.99–1.53)

Absolute Event Rate: 44% vs 29%

p-value: p=0.065

Limitations

Retrospective study design without systematic diagnostic work-up specifically aimed at confirming cardiac amyloidosis.
Red-flag criteria for both scores were applied retrospectively using routinely collected clinical data.
Incomplete documentation of individual score components may have affected score calculation.
Reflects a pre-disease-modifying therapy era, limiting therapeutic implications.
Scores applied were not originally developed to assess differences across flow groups in AS populations.
Limited subgroup sizes, particularly for AS-CA cases within individual flow groups, risking type II error.
Retrospective study design without systematic diagnostic work-up to confirm CA
Red-flag criteria applied retrospectively using routinely collected clinical data
Incomplete documentation of individual score components may have affected score calculation
Data derived from a pre-disease-modifying therapy era
Scores applied were not originally developed to assess differences across flow groups
Limited subgroup sizes, particularly for AS-CA cases within individual flow groups

Implication

In patients undergoing TAVI, a high likelihood of concomitant cardiac amyloidosis is present in about 9% of cases across all flow groups and is associated with increased mortality that is largely driven by baseline comorbidities rather than the dual pathology itself.

Abstract

Background: Aortic stenosis (AS) and transthyretin cardiac amyloidosis (CA) may coexist with overlapping clinical and imaging features. Data on the prevalence of this dual pathology (AS-CA) across AS flow groups are limited. This study assessed the likelihood of AS-CA in different AS flow groups and its association with outcomes after transcatheter aortic valve implantation (TAVI). Methods: We retrospectively analyzed 2764 patients (median age 82 years, 55% male) undergoing TAVI for severe native AS between 2017 and 2022). High likelihood of AS-CA was defined as RAISE score ≥ 3 points together with a T-AMYLO score ≥ 3 + red-flag criteria, or a T-AMYLO score ≥ 7 points. Procedural outcomes and long-term survival were evaluated. Conclusion: Dual pathology of AS-CA is likely present in approximately 9% of TAVI patients and is not confined to specific AS flow groups. Although procedural outcomes are comparable, AS-CA is associated with increased mortality, largely driven by baseline risk. Further studies are needed to improve diagnostic strategies and clarify the underlying mechanisms.

Discussion

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Cite This Study

Schwarting et al. (2026) conducted a cohort in Severe native aortic stenosis (n=2,764). High likelihood of concomitant cardiac amyloidosis (AS-CA) vs. Lone aortic stenosis was evaluated on 3-year all-cause mortality (adjusted for STS score) (HR 1.2, 95% CI 0.99-1.53, p=0.065). A high likelihood of concomitant cardiac amyloidosis in patients undergoing TAVI was associated with higher 3-year mortality (44% vs 29%), which was attenuated after adjustment for baseline risk (HR 1.2, p=0.065).

synapsesocial.com/papers/6a8abc170f137e402b33a8be https://doi.org/10.1016/j.ijcha.2026.101991

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Dual pathology in aortic stenosis: Identifying transthyretin amyloidosis likelihood in patients referred for transcatheter aortic valve implantation

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Dual pathology in aortic stenosis: Identifying transthyretin amyloidosis likelihood in patients referred for transcatheter aortic valve implantation

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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