Cardiac amyloidosis in severe aortic stenosis patients: an updated review unraveling their complex interplay

Aortic stenosis (AS) and cardiac amyloidosis (CA) often coexist in elderly patients, complicating diagnosis and treatment. AS is characterized by the narrowing of the aortic valve, leading to left ventricular outflow obstruction, primarily due to age-related calcification and congenital defects. CA, the most common cause of restrictive cardiomyopathy, results from amyloid protein deposits in the myocardium, causing diastolic dysfunction. Accurate diagnosis of CA in AS patients is challenging due to overlapping symptoms and the need for advanced imaging and biomarkers. Aortic valve replacement (AVR), through surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) methods, is the primary treatment for severe AS. However, the presence of CA significantly impacts perioperative risk and long-term outcomes, with increased rates of heart failure, pacemaker placement, and mortality. Despite conflicting study results, CA in AS patients is associated with poorer long-term survival and more complications. Future research should enhance AI-based diagnostics, explore novel biomarkers, and clarify AS-CA interactions. Gene-silencing therapies and optimizing perioperative management and enhancing patient education are also crucial. Addressing these challenges will improve the prognosis and quality of life for patients with concurrent AS and CA, facilitating better clinical management of this complex dual pathology.