Transthyretin cardiac amyloidosis in aortic stenosis: Prevalence, diagnostic challenges, and clinical implications

Transthyretin cardiac amyloidosis (ATTR-CA) is a challenging and underdiagnosed cause of heart failure. Advances in cardiac imaging have enabled noninvasive diagnosis of ATTR-CA, causing the recent upsurge in disease awareness and detection. ATTR-CA has been increasingly recognized in patients with...

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Bibliographic Details
Main Authors: Giedre Balciunaite, Arnas Rimkus, Edvardas Zurauskas, Tomas Zaremba, Darius Palionis, Nomeda Valeviciene, Audrius Aidietis, Pranas Serpytis, Kestutis Rucinskas, Peter Sogaard, Sigita Glaveckaite, Aleksejus Zorinas, Vilius Janusauskas
Format: Article
Language:English
Published: Elsevier 2020-03-01
Series:Hellenic Journal of Cardiology
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Online Access:http://www.sciencedirect.com/science/article/pii/S1109966619302787
Description
Summary:Transthyretin cardiac amyloidosis (ATTR-CA) is a challenging and underdiagnosed cause of heart failure. Advances in cardiac imaging have enabled noninvasive diagnosis of ATTR-CA, causing the recent upsurge in disease awareness and detection. ATTR-CA has been increasingly recognized in patients with degenerative aortic stenosis (AS). With the growing number of elderly patients undergoing aortic valve intervention, the identification of ATTR-CA in this group of patients is of high clinical importance. Timely and correct diagnosis is essential for amyloid-directed therapies, as well as deciding on the AS treatment strategy. This review provides a comprehensive overview of the recent studies investigating coexistence of these two entities. We present the data on the prevalence of ATTR-CA in AS and their prognostic associations. As the diagnosis of ATTR-CA may be challenging, special attention is paid to the diagnostic utility of different imaging modalities, namely, echocardiography, cardiovascular magnetic resonance, nuclear imaging, and distinctive imaging features, in patients with dual pathology. We also present a flowchart summarizing integrated imaging in patients with suspected ATTR-CA.
ISSN:1109-9666